Back Pain in Student Athletes – PediaCast 316

Show Notes

Welcome to a special sports medicine edition of PediaCast! Dr Eric Bowman joins Dr Mike as Co-Host, along with guests Dr Emily Stuart and Dr Kimberly Wolf. Together they discuss back pain and its effect on student athletes. Topics include spondylolysis, spondylolisthesis, scoliosis, strains and sprains. They also explore the similarities and differences between DOs and MDs. Be sure to tune in!

Back Pain
Muscle Strain
Back Sprain
Osteopathic Medicine
Osteopathic Manipulation
DOs & MDs

Dr Eric Bowman
Sports Medicine
Nationwide Children’s Hospital

Dr Emily Stuart
Sports Medicine
Nationwide Children’s Hospital

Dr Kimberly Wolf
Ambulatory Pediatrics
Nationwide Children’s Hospital

Sports Medicine Program at Nationwide Children’s
Scoliosis – PediaCast 299
American Academy of Orthopedic Surgeons
Pediatric Orthopedic Society of North America
Scoliosis Research Society
American Osteopathic Association
Find a DO


Announcer 1: This is PediaCast.  
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike. 
Dr. Mike Patrick: Hello everyone, and welcome once again to PediaCast. It's a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It is Episode 316 for April 29th, 2015. We're calling this one "Osteopathic Medicine and Back Pain" 
I want to welcome everyone to the program.  
So together, we're going to make PediaCast History today. I'm really excited about this. It's something that's been tucked away in my idea box for a while now. And a couple of development have occurred this year, which took the idea out of the box and put it into action. 
First, the good folks in our Sports Medicine Division approached me about starting a podcast on sports medicine topics. And since I've been doing PediaCast for a little while now, OK, nearly a decade, and I've developed a little know-how in producing podcast — they came knocking with a practical questions related to getting the job done including equipment, and software, and servers, and all sorts of other technical help — well, I jumped on that opportunity, but not for the reason you might think. 
As it turns out, I really love the technical aspects of podcasting in fact, researching and putting together a studio with the right equipment and the software, and figuring out a workable production plan. I kind of look at that as a hobby in the early days, and it's a hobby that helped propel PediaCast forward.  
Now as it turns out, sometimes that knowledge was slow in coming through much trial and error and listening to various podcasts about podcasting. And since then I have shared what I've learned may times in the past with budding podcasters, although I will say most of them run the other way when they find out the amount of time and effort it takes to actually pull this off. And I've shared what I've learned also including equipment and production flow with this audience most recently in Episode 234.  
So the idea of helping new podcast off the ground, it intrigued me. But as it turns out, I was already knee-deep in that process with PediaCast CME, that's our new pediatric podcast for providers which offers free Category 1 CME credit over at, if you'll indulge me in putting in a plug for that. So it's kind of a perfect storm, if you will, to open the box, so my idea could see the light of day. 
All right, so what was my idea? Which really is simple, adding a co-host. Now, not every episode because doctors are busy people, and it's hard to find someone who has the interest and ability of participating on a regular basis. But what if we added a co-host on certain weeks when we're covering certain topics? A co-host who knows a specific field of pediatric medicine exceedingly well which would allow us to have a series of shows on a particular area of expertise within the context of the main show. 
The co-host could choose the topics, schedule the guests, orchestrate the interview, and I could be in the studio chiming in without doing any of the work, which is actually not true at all because there's still lots of work to be done on the production side. And we all know that I have a hard time keeping my mouth shut, so we'll see how that goes. 
Just to reassure you, I'm not going anywhere. I'm still fully invested in PediaCast. This is not something that we're going to do every week, but some weeks we will, which extends our ability to produce more quality content for you because we'll have more hands on deck. 
And so the idea of PediaCast Sport Medicine podcast within a podcast, if you will, we'll call it podcast-ception. It is an idea that is taken flight with our very first co-host, Dr. Eric Bowman.  
So let's say hello to him now. Welcome to the studio, Eric. 
Dr. Eric Bowman: Thanks Dr. Mike. I really appreciate it. 
Dr. Mike Patrick: We really appreciate you forming this idea and coming up with it. Tell us a little bit about your background in sports medicine. 
Dr. Eric Bowman: Yeah, absolutely. I'm a pediatric-trained sports medicine specialist. I completed my medical school training at Ohio University College of Osteopathic Medicine, and then came here to Nationwide Children's Hospital to complete my pediatric residency and decided at that point in time I really love sports medicine, so I stayed on at Nationwide Children's to go ahead and do a one year Sports Medicine Fellowship to get that additional training. 
Dr. Mike Patrick: Yeah, great. And what got you interested in podcasting and bringing sports medicine topics to the podcasting world? 
Dr. Eric Bowman: Yeah. I think for me, the biggest thing was that seeing how PediaCast is able to reach so many people in a lot of different places, it's a great opportunity to reach a lot of individuals on topics they may not be familiar with, but they want to know about.  So we had a group in Sports Medicine kind of come together and say, we really want to try to educate people outside of our bubble of sports medicine. And we really want to reach out there and see what could we got out information-wise. 
Sports medicine's such a huge topic with lots of things to discuss. We wanted to have another window, another outlet to get out there. 
Dr. Mike Patrick: Yeah. And just like anything else, there's so many places where parents can get information, and sometimes it's confusing because you find conflicting information. You don't know who to believe. We try to be evidence-based here and I assume you're going to do the same thing when we talk sports medicine topics. 
Dr. Eric Bowman: Absolutely. You know, everything that we provide to our patients, we discuss with our patients, are things that are evidence-based based off of articles, based off of literature, national meetings, things like that that we encounter and go to in continuing our education. 
Dr. Mike Patrick: Yeah. So what can we expect from PediaCast Sport Medicine in terms of how often are we going to do this? What kind of content have you kind of brewing in your brain right now? 
Dr. Eric Bowman: Yeah, absolutely. We're looking to hopefully do this maybe every couple of months get in here and share some different sports medicine topics with a variety of different guests to come on and help us out here.  
As far as topics, today, we definitely want to talk about back pain. We mentioned that already. Other things that we really want to talk about that are hot topics out there are things like sports nutrition and different ways to maintain the fuels that  your body needs to succeed; different pediatric based musculoskeletal injuries that may be over used injuries like Osgood-Schlatter, Sever's Disease and may be some more serious injuries that people have questions about.  
I know PediaCast does a great job reaching out and having the listeners contribute ideas. We're obviously open to that as well, and we would love to see what some of  the listeners have and what they want to hear about. 
Dr. Mike Patrick: Perfect. And It's easy to get in touch in terms to that. Just head over to and click on the Contact link. Folks can ask questions, suggest show topics. If there's something about sports medicine in the future that you'd like us to discuss and cover, let us know.  
We also have a voice line available at 347-404-KIDS. That's 347-404-5437, if  you need the digits. 
So we're going to talk today about back pain and osteopathic medicine. I've been asked about this question a lot, not only by patients, but also family members. What's the difference between an MD and a DO? So we're going to cover that today as well, right? 
Dr. Eric Bowman: Absolutely. We're going to talk about some of the things that the DOs can do. You hear things like Osteopathic Manipulative Treatment or OMT, or things like that. We're going to go over what that all means and ways that an osteopath can potentially help you with the things like back pain, among other things as well. 
Dr. Mike Patrick: Perfect. And we're going to compare and contrast that with MDs and also with chiropractors as well because when people hear manipulation, that's kind of the first thing that they think about. 
Dr. Eric Bowman: Absolutely. I completely agree with that. We're different. And I think it's important to understand the difference and how we do what we do and why we do what we do. 
Dr. Mike Patrick: All right. We'll take a quick break and we'll get back to that. 
I do want to remind everyone, the information presented in every episode of our program is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you have a question about your child's health, make sure you call your doctor and arrange a face-to-face interview and hands on physical examination. 
Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at 
We do have a couple of guests in the studio today. Dr. Emily Stuart — she's with Sports Medicine here at Nationwide Children's and Dr. Kimberly Wolf, with Ambulatory Pediatrics, also here at Nationwide Children's. We'll get with them, and Dr. Eric will take over the interview when we come back right after this. 
Dr. Eric Bowman: All right. Thanks again, Dr. Mike for that great intro. Again, my name is Dr. Eric, and I'm part of the Sports Medicine team.  
I want to introduce our two guests here today. You got a brief intro already, but first of all, I'd like to introduce Dr. Emily Stuart. She's actually pediatric sports medicine specialist here in Nationwide Children's and assistant professor of Pediatrics at the Ohio State College of Medicine. She did her sports medicine fellowship here in Nationwide Children's as well, and she has a very strong background in gymnastics, both as a participant and as a current judge as well. So she has a lot of experience from that side of things.  
She's definitely no stranger to recognizing, diagnosing, and treating back pains. So we're going to talk to her here in just a second, but I just want to say welcome, Emily. 
Dr. Emily Stuart: Thanks so much for having me. I'm excited to be here. 
Dr. Eric Bowman: Absolutely. Thank you. And then, I just want to go and introduce Dr. Kim Wolf as well. We'll talk with her here in just a few minutes.  

Dr. Wolf is an osteopathic physician or a DO here at Nationwide Children's. As already mentioned, she's in the primary care clinics here. She's an assistant professor of Pediatrics as well. She has several other clinics per week. She really does a great job treating the kids out there with Osteopathic Manipulative Medicine. Don't worry, we'll cover that in a second, what that all means and everything from there.  
Basically, she did her residency here in Nationwide Children's. She's continued to expand her practice here, and has really help the  osteopathic profession grow here in Columbus and also in Nationwide Children's Hospital.  
We'll be discussing osteopathic medicine as well as the variety of different treatments for low back pain and other possible conditions. So welcome, Dr. Wolf. 
Dr. Kimberly Wolf: Thanks, Dr. Eric. I'm excited to be here. 
Dr. Eric Bowman: Excellent. So as already mentioned, today, we're going to talk about low back pain. I think it's pretty well understood that this is a very common condition in adults. We see this a lot. But what a lot of you may not know is, in fact, they are a really common condition in pediatric patients as well. 
Basically, here at Nationwide Children's Hospital, back pain is  the third most common complaint in our Sports Medicine Clinic. And it falls in only behind concussions and knee pain. It actually counts for about 12 to 13% of our complaints in our Sports Medicine Clinic .So it's a really common thing that we see.  
There are several causes of low back pain, and so we're going to talk about some of that here today a little bit as well. We're going to talk about some of the most common causes, including a spondylolysis — or you'll hear it's called a spondy for short, just a little easier to say there  — scoliosis, muscular back pain. We're also going to address some of the ways that they're diagnosed and different treatments as well. 
I want to make sure it's important to know that there are other causes of back pain that can be present, but we're going to focus on the most common causes that we tend to see here. 
And just as a quick note, you heard me mentioned that we're going to talk about scoliosis as one of the causes of back pain. I do want to put just a quick referral in a plug back in that there was a scoliosis PediaCast that was done. It was PediaCast number 299 with Dr. Allan Beebe, one of the orthopedic surgeons here at Nationwide Children's Hospital. That one was released on October 22nd of 2014.  

So I want to make sure that everybody knows that's out there because that episode goes into a lot greater detail of scoliosis and as far as manage from a surgical care point of view and things like that. So, I wanted to make sure that if you have more questions regarding scoliosis that maybe we don't answer for you here today, you can always refer back to that podcast. 
Dr. Mike Patrick: And I'll put a link to that in the Show Notes for this particular episode, so folks can find it easily. 
Dr. Eric Bowman: Excellent. Thanks, Dr. Mike. I appreciate it. 
All right. So, basically, let's go and start in here. Let's start talking about a little back there, all right?  
Dr. Emily Stuart: All right. OK. 
Dr. Eric Bowman: So Dr. Stuart, a couple of questions we have about back pain, and one of the first ones I think that people want to come up with to know is should we expect back pain in athletes? I mean, is it a normal part of being an athlete? A normal part of playing a sport? 
Dr. Emily Stuart: Not really. So back pain can be normal if it's a soreness or I've just used my muscles a lot, but back pain that's  lasting for a while or that's very severe shouldn't be a part of normal sport. But if you work really hard and you had a hard training session and you're sore the next day, then maybe that's okay. You shouldn't stress out about that. 
Dr. Eric Bowman: Yeah. I think it's really important to understand the difference between soreness and pain, right? 
Dr. Emily Stuart: Yes. 
Dr. Eric Bowman: It's one of those things people will ask me sometimes — what's the difference between soreness and pain? And I always like to say, well, think about using muscles you haven't used in a while.
Dr. Emily Stuart: Right. 
Dr. Eric Bowman: And they, "Oh, yeah, I'm a little sore," that kind of thing. That's OK, what you're saying. 
Dr. Emily Stuart: Right. Yup. Exactly. And then, I was also going to add, if the back pain is lasting like more than a week, obviously then, we start to think about OK, is there something else going on? Do I need to get evaluated? 
Dr. Mike Patrick: And maybe if the back pain is making it difficult for you to participate into sports. You're sitting out more because of the pain. 

Dr. Emily Stuart: Yeah. If you can still return to your normal activities, then it's more likely soreness. If it's, gosh, I can't even walk up the stairs, or there's more other symptoms which we'll talk about here in a minute, I think then it would be more concerning. 
Dr. Eric Bowman: And one of the things I guess I have questions about is obviously as sports medicine physicians, we see a lot of the athletes, right? 
Dr. Emily Stuart: Yeah.  
Dr. Eric Bowman: But it's not just athletes who get a little back pain, right? A lot of other kids do as well. 
Dr. Emily Stuart: Yes. 
Dr. Eric Bowman: Are there any thing as you see out there that tend to, just everyday life lead to back pain? Things like heavy backpacks or those sort of things. 
Dr. Emily Stuart: Definitely. And I think a lot of it is poor posture, and then, also the technology that we use if we're always hunched over our cellphones or iPads and in front of our computers, and we're not sitting up straight. That can definitely  contribute to back pain in kids, playing video games and hunched over and just all around poor posture and poor core strength.

I think if you have a heavy backpack, that definitely can lead to back pain. Again, if you have a strong core, that heavy backpack won't be so much of an issue. 
Dr. Eric Bowman: OK. Excellent. And I think you kind of already alluded to length of time worrying about back pain. If it goes over a week or so, those sort of things, we want to pay attention to that. Are there any warning signs? I mean, before we talk about these other common types of back pain, are there any things that parents or athletes or patients in general should know — this is really concerning, this is what I'm more concerned about when it comes to a back pain?  
Dr. Emily Stuart: Yes. So in addition to that, two or three weeks of back pain that's not going away, that would be concerning.  
If you're having fever associated with  your back pain and no other symptoms, unexplained weight loss, pain that's waking you up from sleep, loss of bladder would be a very urgent emergent. That means you need to get to the ER, the urgent care. Radiating like pain is always a little bit concerning or like weakness, those are kind of the big ones. 
Dr. Eric Bowman: OK. Excellent. And then, going a little bit different direction here, once we're in the clinic, people coming with back pain or they're coming in, they're telling their doctor, "I've got some small back pain here," are there any objective measures out there? Are there any things that we can use in the clinic to be able to track back pain to see patient's progress, to see how they're improving, or worsening or anything like that? 

Dr. Emily Stuart: There are some. Most of the objective measures have only been studied in adults, but were starting to study them in kids as well. There's a couple functional scales that we use in our clinics. One is called the McAuley Functional Scale  and the other one is the Oswestry, and these have been adapted a little bit in our clinics to be more relevant to pediatric patients and adolescent patients. But those are kind of objective numbers that we can get on kids to see if their back pain, you know, how severe is it, and is it improving or worsening? 
Dr. Eric Bowman: Wonderful. All right, so let's actually jump in to one of the more common causes now that we see in our clinic regarding back pains especially in some of our athletes. But people maybe hear physicians say or read on the Internet something about spondylolysis. Again, we mentioned before, we call it a spondy for short, but what is that? 
Dr. Emily Stuart: So a spondy is a stress fracture, if the pars interarticularis… 
Dr. Eric Bowman: Big word. 
Dr. Emily Stuart: I know.  
Dr. Emily Stuart: So it's a stress fracture in part of the back,  in part of the vertebrae of the back, the back bones. And so this is the area that's just relatively weak to other areas. We see it. Can we tell you where we see it?  
Dr. Eric Bowman: Yeah. Absolutely. Let's go for it.  
Dr. Emily Stuart: So we see it more commonly in athletes who do a lot of repetitive hyperextension or twistings. So we often see it in gymnasts, and divers, and dancers, sometimes in the football linemen when they're coming up off the line and they have to arch back a lot. And so that is the most common reason we see kids with back pain, actually. 
Dr. Eric Bowman: OK. Do you ever notice it from a traumatic event? Is that something that you'll ever see? 
Dr. Emily Stuart: You can. Yeah. So there have been a couple of cases I've seen where they have really no leading up back pain, and then, they have some big event and it can cause back pain. So it can be either just repetitive over time or a cue to that. 
Dr. Eric Bowman: OK, all right. 

Dr. Mike Patrick: What is the pars interatricularis? What is that? 
Dr. Eric Bowman: That's a great question.  
Dr. Emily Stuart: So that is essentially a joint between one vertebrae and the one below it. And so it's providing stability in between the vertebrae, so that they're not moving in relation to each other in a way they shouldn't.  
Dr. Mike Patrick: Got you. 
Dr. Eric Bowman: It's on the back side of the vertebrae. 

Dr. Emily Stuart: Yes. The posterior element. 
Dr. Eric Bowman: So we know what a spondy is and some of the things that can cause it, but I guess the question now is what are the typical signs and symptoms? How do I know if my athlete or my child has a spondy, potentially? 
Dr. Emily Stuart: Sometimes they present differently than others, but the most common way we see them presenting is pain with extension. It's kind of like a dull achy pain. So the extension means when you arch backwards, like our gymnast when they're doing back handsprings or back walkovers, so have pain. Sometimes they'll have pain a little bit inflection, but usually not as much. A lot of times, they'll have tight hamstrings; sometimes, some stiffness. Typically, it gets a little but better with rest. 
Dr. Eric Bowman: OK. Excellent. And then, I guess some of the other things, do you tend to see a family history component of this to happen? Is there something where you can see low back pain happen or a spondies potentially happen in the family or anything like that? Do you? 
Dr. Emily Stuart: There is. I don't know if there's a lot of study or research out there on that, but we have seen that definitely clinically that I've seen parents who were like, "Oh yeah, I had that one when I was a kid." And so we think maybe there is a familial component, but we don't have a lot of great data on that. 
Dr. Eric Bowman: So, your child come in. You're concerned that they have this spondy potentially with the symptoms you described, but how are we going to figure it out? How do we know? What kind of test can we do to figure this out? 
Dr. Emily Stuart: Starting with just our history, that gives us a lot of information, as well as our physical exam. There's some tests we do on exam looking for it. We also can sometimes see it on X-ray.  Unfortunately, unlike X-rays where you have a nice broken bone that you can see clearly, it's only about 15% to 20% of spondies are picked up on X-ray. So sometimes, we have to do further tests, some kind of advanced imaging.  
There are two main types of tests that you can order. One, is called a SPECT scan. This is a nuclear medicine study. It does involve IV contrast, so an IV is placed, and you have to wait for a little while for the tracer to circulate throughout your body. Then, you take a special kind of X-ray looking specifically at the back,  but it does look at the entire body in general. 
This one does, like I said, involved radiation, but it's the best way to look for an acute spondy or a more recent spondy. 

The other type of test is called an MRI. This doesn't have radiation, and it does pick out most of the spondies, but not all of them . Typically, we'll see some edema or swelling or healing of the bone, but typically, we won't see the fracture line as well as you would on a SPECT scan. 
Dr. Eric Bowman: And one of the things I know that's really nice about a SPECT scan sometimes as well is you can actually get a nice 3D image of the spine and be able to really understand the anatomy and how things are working together there as well. 
Dr. Emily Stuart: Right, and the other thing we do here typically is if we do a SPECT scan, and we see something kind of funny that we're suspicious for, our radiology department will then do a thin slice CT section just to the area of interest, and so that will further characterize relation for us. 
Dr. Eric Bowman: OK, will really be able to narrow and say, "Yeah, we see something," or, "No, we don't." 
Dr. Emily Stuart: Correct. 
Dr. Eric Bowman: Wonderful. OK. So we get this back to the MRI, we figure out there's a spondy there. How do we treat it? 
Dr. Emily Stuart: So that's pretty controversial. So there's no one great way. I was actually at a conference this last week, and I presented research that we're doing on spondies and probably had five different people come up  to me and tell me how they treat spondies, and everyone was different. So the general theory is that you have to rest them, so everyone does that. And then some people do bracing. 

So for the rest part, it's essentially shutting the athlete down completely. So we want them to not use their back as much as possible beyond what they would do in their normal life, like going to school, eating food, you know those types of things, but no running, jumping, swimming, biking, essentially resting. It's not fun.  
And then, once you're pain-free from there, and you've done certain amount of rest from 6 to 12 weeks, then we would get you into physical therapy or functional rehab getting you moving again, teaching you to move your core again, and moving you back into your sports. 
And then the bracing, some doctors who have been trained with doing the bracing feel more comfortable using that, and some doctors don't feel it helps. Both ways I think are right. There's been studies that show both ways work. So it just depends on the physician's comfort and how they have been trained and what they feel comfortable doing. 
Dr. Mike Patrick: That must be really hard for the kids to rest. 
Dr. Emily Stuart: Yes. It definitely is especially these are usually athletes who are very active. We don't want to scare them, but we try to inform them and educate them of why it's important to rest to really get that bone to heal.  
And it's hard because if you break your arm, you can put them on a cast and they're resting. The back, I can't like cast your entire back. 
Dr. Mike Patrick: When you see kids in there in the urgent care, and you tell them to rest for 7 to 10 days, and they cry. I can't imagine six weeks or more. 
Dr. Emily Stuart: Yeah. I usually tell the kids like, "If your parents are telling you to rest, don't get mad at them. Get mad at me because I don't live with you, so It's OK to get mad with the doctor." 
Dr. Eric Bowman: Absolutely. Yeah. I think that's important for them to understand, is how difficult the rest period can be, but how important it is. And I think one of the things that we want to make sure that we take a look at is teaching our patients, making sure they understand. That's really, really important. So you hit it right on there. 
Dr. Emily Stuart: Right. 
Dr. Eric Bowman: So I guess the big thing is do you typically find that patients listen? Do they typically rest? I mean… 
Dr. Emily Stuart: Typically. Or, at least, they tell me they are. 
Dr. Eric Bowman: Okay. At least, they get better. That's what matters, right? 
Dr. Emily Stuart: Right. Yes. So I would say most of them do. Most of them follow the recommendations that we give to them because, again, they know they want to get into sport. And if you can teach them that perspective of this is only eight weeks of your entire life, and if we don't do it right now, we're going to start back at step one and have to start all over. They're usually pretty good, even though they're feeling good after a couple of weeks. 
Dr. Eric Bowman: So I guess my question is, OK you've got that athlete who doesn't want to listen to you. And they say, "You know, doc, I hear what you're saying, but I'm going to still play rugby. I'm still going to play football, right?" 
Dr. Emily Stuart: Yeah. 
Dr. Eric Bowman: So they go out there, and they keep doing what they're not supposed to be doing with the spondy. What kind of complications can happen if they don't do the rest they're supposed to? 
Dr. Emily Stuart: Well, one is they're going to continue to have back pain, and it's never going to go away, so that's going to be problematic. But the big one we always worry about is something called is spondylolisthesis. So It's even a bigger word than the spondy word. 
So what that is this if you have that stress fracture on both sides of the pars or both sides of the vertebrae, you can start to slip forward and have that what we call spondylolisthesis. And that can have more complications. 
Dr. Eric Bowman: You said it can have more complications. 
Dr. Emily Stuart: Yeah. So… 
Dr. Eric Bowman: What kind of things can you see from it? 
Dr. Emily Stuart: Sometimes this does not need surgery. Not usually, but occasionally, if they get severe enough, it does need surgery. 
You can have worsening pain. You can have radiating pain, buttic pain, sometimes if it's really bad even some muscle wasting. So your legs aren't strong as they used to be. And then, more severe would be even loss of bowel or bladder control. So if you tell kids that, they'll be like, "OK I don't want that," so usually, they'll listen. 
Dr. Eric Bowman:  So I guess the big thing is listen to what your doctor's telling you, right? 
Dr. Emily Stuart:  Exactly. 
Dr. Eric Bowman: That's easily kind of the underlying theme I'm hearing here. 
Dr. Emily Stuart:  Yeah. We don't just… You know, if I had it my way, I wouldn't make everyone rest, but I know that's not going to help them. So I don't do it just to torture them. 
Dr. Eric Bowman: I guess, looking at spondies, we talked about how bad the complications could be I guess? What ways if any are there out there to potentially prevent spondies? Is there anything an athlete can do to try to hopefully prevent this condition? 
Dr. Emily Stuart:  Yes, making sure that they have really really good core strength, so that the core isn't just your abs. It's your back. It's your hips, your gluteals. So making sure all of that is working really, really well. They have adequate flexibility. They're not overdoing it. So if they do start to have a little bit of achiness and pain, that they're backing off and seeing if they get better. And if they aren't getting better, that they let their coach, their parents, someone know, in case they do need to get seen. 
Dr. Mike Patrick: Is that something that's pretty common in the gymnastics world? 
Dr. Emily Stuart: Yes. I was actually a gymnast growing up, and I have this condition. So yes, it's common to have some back pain. Having the spondy is pretty common as well. It's sometimes hard for gymnasts because they want to do well, and they want to please their coach. So it's important that the kids know it's not a great idea to hide their pain. 
Dr. Mike Patrick: And I suspect when you get up there to the championship level, and like people who are looking to going on the Olympics and that kind of thing, there's probably folks who really have it and just keep pushing and pushing. 
Dr. Emily Stuart: Definitely. And a lot of the kids would come in after season and say, "Gosh, I've been having pain for four months. I just, you know…" But their friends were like, "Well, you just told me a week ago." So they want to push through. 
Dr. Mike Patrick:  And even worse than that, you have the parents who push their kids through it. 
Dr. Emily Stuart: Right. So, if your kid is telling you they're having back pain, it's important to get it checked out. 
Dr. Mike Patrick: Take it seriously. 
Dr. Emily Stuart: Yup. Now, again, going back to the beginning of what we're talking about, if they come home and say, I had back pain today, and that was it, you don't need to rush to the ER. But if it's kind of a consistent thing or it's really bugging him, let us know. 
Dr. Eric Bowman: Yeah. And I know one of the things you mentioned too, that you can see the spondies are the tight hamstrings, and so flexibility — stretching, warm ups, cool downs — are those things that you really think can hopefully be prevented for some of these conditions as well? 
Dr. Emily Stuart: Yes, definitely. So not jumping right in, making sure you do warm up properly, just like you said. Stretching, especially those hamstrings, stretching your hip flexors, those are all going to be really important. Most of the times, especially like in gymnasts, they have tight hip flexors and their lumbar spine, they're always arching. And so, making sure that their hips and their back and their cores are strong and flexible, and that they're warmed up properly is very important. 
Dr. Eric Bowman: Well, it definitely sounds like spondies are really important thing we want to make sure we're aware of, and we can recognize in the clinic when it comes in. 
So let's move on to another potential cause for back pain here. That's scoliosis. You know, I know a lot of times people go, "I've heard scoliosis, but what is it?" 
Dr. Emily Stuart: So scoliosis is essentially deformity of the spine. And if you look at a person straight on instead of being straight up and down, their spine is kind of more an S shape or a C shape. Most of the time, we don't know why this happens, so we call that idiopathic, but that is what scoliosis is. 
Dr. Eric Bowman: Typically, when you see somebody with scoliosis, if it's a mild scoliosis, that's not a significant curve of the spine. Does it usually cause a lot of problems for them or…? 
Dr. Emily Stuart: No, typically not. So a scoliosis is a curve more than ten degrees. So I get X-rays on someone for whatever reason, and there's an eight degree curve, your doctor might mention that to you, but that's not technically considered scoliosis. That's just a spinal asymmetry.  
So scoliosis is, like I said, is more than ten degrees. And less than 20 or even 30 degrees typically doesn't cause problems. In the literature, most of the time, we're taught that scoliosis doesn't typically cause back pain, but I would say clinically, in my practice and probably in other people's practice, they'll notice a lot of patients with scoliosis do have back pain. So whether or not that's due to the scoliosis or something else, hard to say, but clinically, I would say it can cause pain. 
If scoliosis gets really bad, then we can have problems. If you have a curve of 70 to 80 degrees, you might have problems with your lung function, per se. 
Dr. Eric Bowman: And that's where, again, I know we talked about… Dr. Beebe was here last fall talking about that as well and some of the surgical options that they can do for scoliosis at that point, and if they need to. 
Dr. Emily Stuart: Right, yeah. So typically, you might have… Some of the parents maybe even remember those big giant braces that they put people in. They don't brace a lot anymore. Bracing typically, they'll do if the curve is more than about 25 degrees. The bracing doesn't fix the curve. It really only prevents the curve from progressing, and then, the bracing usually helps if they're scarcely immature, so a younger prepubescent kid. 

And then, surgery usually isn't until their curve is about 50 degrees, and then it does need to be fixed in. We'd prefer you teen orthopedic surgeon for that. 
Dr. Eric Bowman: So you talk about that prepubescent kid, that kid who still has a lot of growth ahead of you. Why is that an issue? What creates a problem if you still get a lot of growth left? 
Dr. Emily Stuart: So if you have a curve of let's say 20 degrees and you are 9 years old, we expect then as you grow taller that the curve could progress and become more of a degree, more angulated. So that would be an important one to watch pretty closely and consider bracing on. Whereas, if you are 17 years old and you're done growing, the curve shouldn't change much anymore. So those younger kids could still change. 
Dr. Eric Bowman: Typically speaking, people may be told they have scoliosis or they may be concerned about scoliosis. How do you usually diagnose it? What's the best way to figure out if somebody has it? 
Dr. Emily Stuart: So sometimes, parents will notice it. Often if a kid's  in a bathing suit, and they'll say, "Oh gosh, her hips are a little crooked," or, "Her shoulder blades look a little crooked." So they may come in concerned about it. Or some schools still do screenings.

Some doctors, doctors should do it in at their annual visit, should bend the kid over and do what's called an Adam's Forward Flexion Test where they're looking for one side of the trunk being higher than the other. That's how we pick up scoliosis. It's that physical exam maneuver. And if we see something that looks a little crooked, then we would get X-rays to further diagnose it. 
Dr. Mike Patrick: I just want to point out, too — parents, make sure that's getting done during a physical exam. And especially if you go to, I don't know, you're going to save a few bucks and go to your neighborhood pharmacy quick clinic to get your sports physical. Again, I might get myself into trouble when I say these things, but you want to make sure that that gets done. It's important. 
Dr. Emily Stuart:  Right. Yeah, it's an important part of the annual physical. It's a really quick easy  test. You stand them up, you bend them over. You look at their back, look for asymmetry. It takes probably less than twenty seconds. 
Dr. Eric Bowman: And like you said, it's a really valuable part. It's something we don't want to miss. We want to be able to make sure we can address it, so it doesn't become a bigger issue further down the road. 
Dr. Emily Stuart:  Exactly , yup. 
Dr. Eric Bowman: Now, I know you talked about the variety of treatments to try to help slow the scoliotic curve, right? I guess my question is, is there anything that corrects it? Is there anything that takes it away? Is there anything that, say your child has that 15 degree curve, is there anything that we can do that totally correct the curve? I mean, that you know of? 
Dr. Emily Stuart:  Not other than surgery, not really. So there's a lot of information out there and a lot of different exercises and stretches that people, you can find on the internet. But as far as the evidence goes and the research goes, there's nothing that's been proven to make the curve go away or to prevent it from getting worse other than the things we've talked about — the bracing and the surgery. 
So I think, exercising is obviously great and stretching is great, but it's really not going to fix the scoliosis. 
Dr. Eric Bowman: What about preventing it? Let's say your somebody who's genetically, maybe your family has it. It's something maybe that you're at risk for. Are you going to be able to do stretches and exercise and things like that to prevent it from happening? 
Dr. Emily Stuart:  Unfortunately, no, not as far as we know, but it's good to know if you do have that family history, so that you can make sure you're getting screened frequently to make sure you're not missing it and waiting until it's too late. 
Dr. Eric Bowman: So, you're going to your doctor's office, and you're diagnosed with scoliosis, is there any sort of following or continued check-ups or anything like that that you're doing to monitor the scoliosis, to make sure it's not getting worse? Do you do anything like that? 
Dr. Emily Stuart: Yeah. So depending on the curve and depending on the age of the child and their bone maturity, we'll continue to follow it, and it will be either with clinical exam and/or X-rays. So they may be in three-month increments or six months or even a year. And then as you get older, maybe even only every two years, you need to come in and get seen, but it should be followed once you are diagnosed with scoliosis. 
Dr. Eric Bowman: So I guess, the question now is, all right, you're the sports med doc. I got a question. My kid has scoliosis, "Doc, can they still play? Can they still do sports?" 
Dr. Emily Stuart: Definitely. So scoliosis, you can go and run and play and do any sport you want. Doing sports will not make it worse. We encourage them to do sports because typically that often can make you feel better, too. 
Dr. Eric Bowman: Excellent. And I think the last thing I kind of want to talk about from the low back pain standpoint of one of the more common causes we have out there are muscular causes of low back pain — things I think people are maybe a little more familiar with and maybe have a little bit more experience with. Do you see muscular low back pain and muscular pain as a cause in your clinic? 
Dr. Emily Stuart: Yes. It's a pretty common cause as well, like we've talked about earlier, if you have poor posture or if you started a new sport and you've become more active, you can have that muscular spasm, muscular tightness. So making sure you're stretching and warming up and easing into sports is going to be really important. And then, making sure you have good posture throughout the day is important as well. 
Dr. Eric Bowman: That's always a good tip, right?  
Dr. Emily Stuart: Yup. 
Dr. Eric Bowman: Grandma was right, I guess? Right? 
Dr. Emily Stuart: I know. 
Dr. Eric Bowman: Sit up straight, you know? It's always important, so all right. 
When it comes to some of the muscular low back things, people would hear like sprain versus strain of the low back. What's the difference or is there a difference? 
Dr. Emily Stuart: So they are often used interchangeably, typically, a sprain is more of a ligamentous injury and a strain is often a muscle or tendon injury. It's how it's typically taught in the medical literature. So probably in the muscular strain-sprain, it's very similar for the back issues. 
Dr. Eric Bowman: Typically, what do you see is the cause is? I mean of muscular strain or the sprain or whatever that may be in there. 
Dr. Emily Stuart: Yeah, so a lot of times again, tight hamstrings, not warming up properly, just working too hard, too fast are kind of the main ones. 
Dr. Mike Patrick: Overuse. You're doing repetitive motions, doing the same thing. 
Dr. Eric Bowman: Overuse. 
Dr. Emily Stuart: Yeah, right. Right. And so then, it's tricky sometimes to diagnose and differentiate the causes of muscular strain versus a spondy for example. Because if you've done a whole bunch of a repetitive motion, then it can cause pain and strain, but it can also cause the spondy. 

Dr. Eric Bowman: And as far as general risks with muscular low back pain and things like that and strains, are there any particular activities or sports you notice that tend to be high risk? I mean, I see somebody with this sport, I'm a little bit more concerned maybe about a muscular strain in there. 
Dr. Emily Stuart: Yeah, so sports we've already touched on — so gymnastics is a big one. As much as I love the sport, it can cause a lot of back pain, Diving , dancing, football is a big one, but even things like lacrosse and baseball, we see a lot of back pain and muscular strains from. 
Dr. Mike Patrick: Bowling. 
Dr. Emily Stuart: Yeah, probably, bowling. Yeah, sure. 
Dr. Eric Bowman: Absolutely. 
Dr. Mike Patrick: The balls heavy. 
Dr. Emily Stuart: We do see some bowlers in our clinic. Not a ton, it's not a huge sport here in Ohio, but we do see bowlers. There are some high school bowling teams. 
Dr. Eric Bowman: Absolutely. And assuming that no matter what the sport, the bottom-line of the things we've already talked about with good core strength and good flexibility, those are things that still absolutely are crucial to helping to prevent  some of these injuries. 
Dr. Emily Stuart: Yes, definitely. Like you mentioned, no matter the sport. And we see spondies in every sport, and we see muscular back pain in every sport. So it's important even if you're not doing a high risk sport that you're still doing the warm ups and the stretching. 
Dr. Eric Bowman: Well, what about initial treatments? So somebody comes in with what really does look like to be a low back strain, pull the muscle per se or whatever, right? 
Dr. Emily Stuart: Yeah. 
Dr. Eric Bowman: What's the initial treatment a lot of times that you'll do for that?

Dr. Emily Stuart: Yes. So avoiding things that hurt a lot. We don't really recommend bed rest. That's never a good idea. You can do some ice and some ibuprofen, and then doing some physical therapy, doing freehab which is functional rehab that's done by athletic trainers and so they can progress you kind of back to your sports-specific exercises. And also doing some osteopathic manipulative therapy is a great treatment option.  
Dr. Eric Bowman: Love it. Excellent. And I think that's what's really important. And I'm kind of jumping a little bit so I know what Dr. Wolf's going to talk about here, but Osteopathic Manipulative Medicine, there are a lot of studies out there, more in the adult world, but we really can use them in the pediatric world as well for that low back pain. Treatment with OMT is really effective, so I always tell people, think about that in the back of your mind as a possible treatment course as well. 
Dr. Emily Stuart: Yes. 
Dr. Eric Bowman: Excellent. Well, one of the questions that happens or comes up a lot is this whole debate with low back pain and ice versus heat? Is there a right way? Is there a wrong way? What's the better option? When would you use one versus the other, I guess? 
Dr. Emily Stuart: So I'm more of an ice person. So Ice is better typically for an acute injury or if you've worked out really hard doing some ice, if you are about to practice and you're getting ready to warm up and you're going to stretch, doing some heat to kind of loosen those muscles is an OK idea. But typically, ice if you've had an acute injury or you're sore is a good idea. 
Dr. Eric Bowman: And what about medications? Do you ever use any kinds of medication for these injuries? 
Dr. Emily Stuart: Yeah. Typically, you can use some ibuprofen or Aleve is good to use. I don't like to use that a ton, especially as a prevention for preventing your back from hurting.  If you know you're back is going to hurt if you go to practice today, then you probably should get it checked out, not mask it with some kind of anti-inflammatory. But if you've injured it, obviously doing ibuprofen is fine. An ice pack is actually a little bit better, I would say, anti-inflammatory because it's going right to the source of where you put it. Whereas, the anti-inflammatory is kind of going everywhere. 
Dr. Mike Patrick: Just so parents get in their mind why ice is better, because it causes vasoconstriction, so it decrease blood flow to the area, and you need blood flow in order to get it swelling. 
Dr. Emily Stuart: Yes. And so if we can prevent that swelling, that's going to be better for the kid. 
Dr. Mike Patrick: But if you do heat, then that's going to cause vasodilation, so we get increase blood flow to the area and that can increase swelling. 
Dr. Emily Stuart: Exactly. 
Dr. Mike Patrick: Absolutely. 
Dr. Eric Bowman: Absolutely. Yeah, so I guess, the overall theme I get from low back pain is that it's not something that we necessarily want to rush into getting checked out immediately if it's a day or two, but if it goes on a period of time ,we really should take it seriously, and we should get it looked into. And we want to make sure we just don't play through the pain, push through the pain. 
Dr. Emily Stuart: Right. 
Dr. Eric Bowman: We need to get it checked out, and we need to make sure that we respect it and make sure that there's nothing more serious going on there. 
Dr. Emily Stuart: Exactly. You'll only get one back in this life, so you got to treat it with respect.  
Dr. Eric Bowman: Excellent. Well, Dr. Stuart, I really appreciate your time talking about some of the low back pain issues that we can find more commonly in the sports clinic.  
So, we mentioned earlier the Osteopathic Manipulative Medicine and the treatment and there may be a lot of parents out there right now who are going, "What is that? What is an osteopathic physician? What is a DO? What does that all mean?"  
And so again, Dr. Kim Wolf is here with me, and she's going to talk about this a little bit. We're going to kind of go in to what osteopathic medicine is and how we can use it and some of the great options that it opens for treatment and thing like that. So thanks again, Kim for coming. I really appreciate it. 
Dr. Kimberly Wolf: Thanks for inviting me. 
Dr. Eric Bowman: Absolutely. So I guess I'll just going to start by asking a general overarching question, what is osteopathic medicine? 
Dr. Kimberly Wolf: So osteopathic medicine was founded back in 1874 by Andrew Taylor Still. He was actually an MD. At that time, there was a flu epidemic going on, and he started noticing that kids actually that he puts his hands on and sort of felt bones were not in specific alignment or fell a little out of place to him. And he noticed when he put them back, those kids tended to do better overall and had better recovery. 

He didn't like a lot of the typical medicine that was happening at the time — things like using leeches and bloodletting or draining them with their blood. 
Dr. Eric Bowman: Funny stuff. 

Dr. Mike Patrick: That's kind of embarrassing to us MDs, you know? 
Dr. Kimberly Wolf: And so, he was really excited when he found that noticing that he could put his hands on people and they tended to do better. So, he started exploring this more, and from there branched out and founded osteopathy or osteopathic medicine. 
Dr. Eric Bowman: So that's the foundation. You mention that he was an MD who kind of figured this out himself. You're a DO; I'm also a DO. I know Dr. Mike and Dr. Emily are both MDs, so what's the difference? I mean when people see those two letters behind our name, what does it mean? 
Dr. Kimberly Wolf: So MDs and DOs are trained almost identically. We both have four years of medical school, and then we have to go through internship and plus or minus a residency, depending on what you would like to do with your career and how you'd like to specialize. 
Once we're done with medical school, we're all eligible to take the same board exams. We're all eligible to be any specialty that we'd like including pediatricians, surgeons, orthopedist like we were talking about earlier. So we can go into all of these different fields and do the same thing.  
And, most of the time, when you see me in my clinic, I'm a general pediatrician and you'd never know what the initials after my name are. But what makes me a DO is that I have a little bit of extra training in musculoskeletal medicine, and specifically in using Osteopathic Manipulative Medicine or OMM to help treat the musculoskeletal system. 
But fortunately, OMM can also be used to treat several things beyond the musculoskeletal system, which we'll talk about a little later. 
Dr. Eric Bowman: Excellent. So it's an extra tool in your tool box per se.  
Dr. Kimberly Wolf: Exactly.  
Dr. Eric Bowman: How nice. Well, I guess, a lot of people may have the question and a lot of parents, how does this work? I mean how does osteopathy work? What are you trying to work on? What are you trying to do as part of the treatments? 
Dr. Kimberly Wolf: So one thing that osteopathy stresses is the interconnectedness or interrelatedness of all of the body. So if one thing isn't working — maybe the spine for example — lots of it are things not working.  
And an example of that is, say you've got back pain, well, there's lots of nerves coming out of the back, and if those nerves are being pinched, you can have other problems like constipation or even troubled breathing. Or, if you have really bad headaches because of neck pain, that often interrelated and due to muscle problems in the neck. 
So there's a lot of overlap in how the body works and how the body functions. Also, things like the diaphragm, which is the muscle below your rib cage. If that's not working properly, things like lymphatic fluid, which is fluid that helps your body fight infections might not move as well throughout the body. So it can't help with healing infections or even healing those strains and sprains that we talked about earlier.  
Dr. Eric Bowman: So you're not kidding? It really is interconnected? Everything? 
Dr. Kimberly Wolf: It is. Everything is related. 
Dr. Eric Bowman: OK. Everything affects everything else. 
Dr. Kimberly Wolf: Yes it does.  
Dr. Eric Bowman: That's really great to know. So I guess one of the questions I have is, we're talking about DOs versus MDs. I  mean, are there a lot of DOs in the US? 
Dr. Kimberly Wolf: There are a lot of DOs, and we are a constantly growing field. There's currently 92,000 DOs in the United States, but just in the last few years alone, I think we've five or six new osteopathic medical schools have opened. And so, we are expected to just continue growing and be more present in the medical world in the near future. 
Dr. Mike Patrick:  And here in the Midwest, we're kind of used to seeing DOs, just because it seems to me… The first one is in Kirkersville. 

Dr. Kimberly Wolf: Kirksville, yeah. 
Dr. Mike Patrick: Kirksville, oh, I was close. 

Dr. Kimberly Wolf: Very good.
Dr. Eric Bowman: Not bad for an MD. 
Dr. Kimberly Wolf: No, not bad. We'll let you slide. 
Dr. Mike Patrick: It seems to me, the schools kind of heavily concentrated in the Midwest is that true? 
Dr. Kimberly Wolf: There are. There are a lot of schools in the Midwest. However, we're growing and expanding especially in the south recently. There has been more schools opening. I think Georgia had one. Florida has two now, I believe. Georgia may have even got second one. Tennessee has one. Kentucky has one. So that's a region that are up and coming. 
There's still actually a lack more in the North East. So, there's one in New York, there's one in Philadelphia, but not too many more. There's one in Maine, but there's a scarcity out there. Out in the West Coast, they've opened a new school up in Oregon. My school has actually trained at the College of Osteopathic Medicine of the Pacific in Los Angeles, and we opened a branch campus up in Oregon. So there, we're growing and expanding, but there are still definitely pockets where DOs are more popular and more present. 
Dr. Mike Patrick: But if you haven't come across some, they're coming soon to a city near you. 
Dr. Kimberly Wolf: Absolutely.  
Dr. Eric Bowman: They're out there for sure. All right. So, we've talked about DOs, and we've thrown around the terms Osteopathic Manipulative Medicine and Osteopathic Manipulative Treatment, and we've talked about how it's interrelated and taken a look at how all the systems connect and that's what we can treat. The question that I seem to get a lot and that you may as well is, how are you different than a chiropractor? What's the difference there? 
Dr. Kimberly Wolf: So that's a question I get almost daily in my clinic. I'm different from a chiropractor in a lot of ways. So the biggest being that I am actually a physician. I'm actually a doctor.  Although, they are called doctor, that's just the name of their degree, but they're not actually physicians and not equivalent to us.
 They cannot prescribe medicines. They cannot specialize in the way that we can, so they cannot be a pediatric chiropractor for example. They may claim to be, but they're not structured the same way we are as physicians. They are also not as closely monitored, and often times not covered in insurance because of that, since they are not true physicians. 
Dr. Eric Bowman: OK. So I guess, you talked about the differences between the two, but I guess a lot of people hear the word manipulation and they go, "Well all manipulations just popping and cracking, right?" I mean, that's what manipulation is. So is that true? 
Dr. Kimberly Wolf: That is so not true.  
Dr. Eric Bowman: So then, I guess, what's the difference then? 
Dr. Kimberly Wolf: So Osteopathic Manipulative Medicine, or OMM as we call it, it also has many other names. It sometimes goes by OMT, which is Osteopathic Manipulative Treatment or Osteopathic Manipulative Therapy. There's also the term NMM which is Neuro Musculoskeletal Medicine, which is a new trend  to call it that in our field. But no matter what you call it, often times in my clinic I just call it manipulation.  
What we do with it is help the body heal, and we do that by putting things back where they're supposed to be. So sometimes that can be accomplished with cracking and popping, but there's lots of other ways to do it as well. But we also help things work better. We stretch out tight muscles, so like Dr. Stuart was talking about earlier, those tight hamstrings and hip flexors, I can help stretch those out and help your body heal after a strain or sprain. 


So overall, just to help the body work and function better because when the musculoskeletal system is working better, that's part of that whole body that we're talking about earlier and other things will work better too. 
 As far as other types of techniques, so there is the cracking and popping which we as osteopaths call HVLA which stands for High Velocity, meaning really fast, and Low Amplitude, meaning we don't push far. So when we do crack and pop, they're very localized, which I think is very different than chiropractors. They tend to often take the whole back and you know. I have a lot of families that describe it to me as, "Well, he just picked her up, and the whole spine just cracked."  
When I crack or pop — which I always discuss with families before I do and make sure they're comfortable and also make sure they don't have risk factors like a spondy — it's one vertebra at a time. It's very focused. Or one rib at a time just to put it back if it's a little bit out of place. 
But I also have lots of other ways of doing that. There's things called Balanced Ligamentous Tension where I use the ligaments that the body has to help put things back.  
There's soft tissue types techniques which almost feels more like massage and works on the muscles.  
There's also something called myofascial release, which works on fascia. Fascia is kind of this tissue that encloses all the muscles and bones and everything else in the body. It's kind of like saran wrap. So when you pull on one part of the body on the fascia there, it's felt on other parts of the body. And so, some of the techniques I use treat that. 
There's also something called cranial osteopathy or osteopathy in the cranial field. I use that to treat a wide variety of conditions, including concussions. Or I even treat babies who have misshapen heads, and that's very gentle, and my touch is almost not even pop-able. You can barely tell that I'm even touching you with that. 

And so, we have a whole spectrum of technique that we can use, and I discuss all those with families and patients and let them know that if ever there's something they don't like or technique that I'm using they're not comfortable with, that I've got lots of different ways to approach it and treat it. 

Dr. Eric Bowman: Excellent. That sounds really great. It sounds like again, you've really brought that extra tool to the tool box and really find something else above and beyond medications or things like that even. 
Dr. Kimberly Wolf: Yeah. Osteopathy is really great for especially the pediatric population because although NSAIDs like Motrin and ibuprofen and things like that work really well at helping relieve pain acutely, they're often aren't going to fix the pain long term, and they're medications that aren't meant to be taken every day. That's where I come in, to help fix the problems so that the pain is not an ongoing thing, and they don't need to rely on these medications in the long term. 
Dr. Eric Bowman: That sounds really, really great. So there may be a lot of parents out there who were going, "Wow, this sounds really interesting. This sound like something I could hopefully, if I could find a DO near me, that maybe I could be interested in learning more about her or maybe even having my child treated with." Is there a way that they can find out if there's a DO near them who does this sort of things? 
Dr. Kimberly Wolf: Yes. So if you're here in Columbus, I'd love to put in a plug for my clinic. 
Dr. Mike Patrick: Please. Please do. 
Dr. Kimberly Wolf:  You're welcome to come see me. I'm located at our Hilltop Primary Care Center. We're part of Nationwide Children's Hospital, and we're located at 2858 West Broad Street. You don't need a referral to come see me. You just call our clinic — it's 614-355-9900 — and say that you'd like an appointment with Dr. Wolf for OMM. 
My clinic is currently held on Monday and Wednesday mornings from 8 to 12, and also on Tuesday evenings, which is a great option for kids who don't want to miss any more school, or families who can't miss work. So keep that in mind as well. 
Again, you don't need a referral, just call and ask. And we're hoping to continue expanding and have more dates and times available soon as well. 
Dr. Eric Bowman: Wonderful. And I know one of the other things that if you're not near Columbus area, I think the website to the American Academy… 
Dr. Kimberly Wolf: You can do either the American Academy of Osteopathy or the American Osteopathic Association. Or if you just Google, "find a DO", that will take you to the AOA's website, and you can put in your Zip code and things like that.  


When you go look at that website, if you are looking for someone who specifically does osteopathic manipulation, there's something, a box to choose a specialty and you want to click on OMM, and I believe it has NMM listed as well which is the Neuro Musculoskeletal Medicine. 
Dr. Mike Patrick: Great. I want to just talk about  chiropractors for a second here again. It's just like any other field of medicine. You got people who are out there on the fringes and doing things that aren't safe. And then you also have some people who really do care and try to stay evidence-based. So it's easy to just talk about folks as a group of people and generalize.  
But I do know that there's this… And I've kind of changed in my thinking about this a little bit, although not necessarily with little kids necessarily, but it does seem like there's this movement within chiropract… I don't know how you would say that, chiropractory for a specific… I don't know, have you heard of this term? Like specific chiropractors? 
Dr. Emily Stuart: I haven't specifically heard of that term, no. 
Dr. Mike Patrick: Because it sounds like it's a lot like the kind of manipulation that you're talking about, the training that goes on in this. In my own personal experience with this is… Well, first I would say I have a friend, and he got his neck cranked on. And he had a stroke afterward because they sheared a vertebral artery. I'm sure it was a cause and effect, I mean I don't know for sure, but he had a seizure within a couple of hours having this manipulation done. And then he had a problem in his neck where the manipulation had occurred. So, you've got the big manipulation, I guess you'd say. Not the Low Amplitude. 


And then on the other hand, my wife has seen this chiropractor who does specific chiropractory. I'm actually his personal friend, and he uses this thing that looks like a drill. But it just like gives a little thump in the neck and you would not think that this does anything at all. She can have neck pain that really is not debilitating, but it makes a big difference. 
And so, I do wonder if some, maybe if there's a movement within the field of chiropractors to be more evidence-based and to look at this specific kind of things. 
Anyway, I don't want to throw all of them under the bus.
Dr. Kimberly Wolf: No. I agree. 
Dr. Mike Patrick: On the other hand there are dangerous things that happen.  
Dr. Kimberly Wolf: I agree. There's good and bad in every field, and so you have to be careful, do your research and make sure you find someone that you're comfortable with and you trust.  
One thing I do like about being a pediatrician is, again, I'm very comfortable treating a wide range. The youngest I've treated was literally a few minutes old. And so, I'm very comfortable with putting my hands on different kids and different age ranges, and I understand their growing skeleton and some of the differences in their biomechanics and how things are working in their bodies. So that's just one other thing that makes us unique especially as pediatric osteopath. 

Dr. Mike Patrick: And you know the limitations of manipulation as well, and so it's not a cure-all for everything. You know it's not going to treat every ear infection. 
Dr. Kimberly Wolf: Correct. 
Dr. Mike Patrick: Or is not going to make every asthmatic better. 
Dr. Kimberly Wolf: Correct. But it does work for both of those things. 
Dr. Eric Bowman: Right. And I think one of the things that's important to understand that I always explain to people as well when it comes to manipulation is you're not going to use an antibiotic to treat a broken finger, right? 
So there are different types of manipulation out there that worked for different things. 
Dr. Kimberly Wolf: Yes. 
Dr. Eric Bowman: And so that's not just a catch-all-throw-all, throw something at them. With just like any other treatment out there, whether it's a medicine or other thing, there are benefits, and then there are potential side effects as well. And so it's important to have that discussion with your child's osteopath and to make sure that  you're comfortable with what they're going to be doing to you or your child. I think  that's a very important thing to make sure, that you feel comfortable with it. 

Dr. Kimberly Wolf: Absolutely. I think you described it perfectly as it's just one more tool in our tool belt to use, and one more option to give families and patients to get some relief from whatever they're experiencing. 
Dr. Eric Bowman: Excellent. Well, is there anything else that you wanted to throw out there about osteopathic medicine in general or anything else that you want the parents to know? 
Dr. Kimberly Wolf: I just want to list and talk about some of the other things that I do treat. Like I said, I do treat infants. So I see kids who have flat spots in their heads, I know that's a common thing now with the promoting sleeping on their back. Also kids who tend to only look to one side more than the other, we call that torticollis. But if you notice that your baby is looking to one side more than the other, osteopathic manipulation can help that. 
I see a lot of infant with colic or babies who have trouble, especially with breast feeding and latching, so they can come see me for that as well. I do treat ear infections, allergies, asthma, constipation, as well as all the back strain and sprains, knee pain. I see all of those things as well.  
So, I get lots of referrals even for kids with scoliosis. I personally think that a lot of pain that comes with scoliosis has to do with the tight muscles  that are getting tighter around those curves because the curve is not normally shaped. And so where I come in and treat those kids is loosen up those muscles and help their spine move better and work better. I get a lot of great relief in those kids. 
Dr. Eric Bowman: Absolutely. And again, I think that's important to you to know is that you can rebut a lot of pain relief there which is helpful.  
Dr. Kimberly Wolf: Yeah. 
Dr. Eric Bowman: So all right, wonderful. 
Well, I wanted to thank Dr. Stuart and Dr. Wolf again for coming out and join us in our initial PediaCast Sports Medicine here and for sharing some valuable information on osteopathic medicine and back pain in athletes. So thank you ladies.  I really appreciate it.  
Dr. Kimberly Wolf: Welcome. 

Dr. Eric Bowman: So, I think we're going to take a quick break here, and then I will take you back to Dr. Mike when we're all back from that. 
Dr. Mike Patrick: Yup. That sounds great. Actually, there's something that's been brewing in my mind  And I didn't want to interrupt and throw the bus off the road. 
Dr. Eric Bowman: Interrupt anytime. It's OK. 
Dr. Mike Patrick:  No, no, no, no, no. Dr. Stuart, someone mentioned that you are a judge for gymnastics now? 
Dr. Emily Stuart: Yes. 
Dr. Mike Patrick: That must be really fun. 
Dr. Emily Stuart: It is really fun. It's actually really fun too because some of the kids I judge, I then see in clinic. 



Dr. Emily Stuart: And so that's a really good way to get kids to do what you tell them to do. 
Dr. Mike Patrick: Yeah. Yeah. 
Dr. Emily Stuart: And I tell them, " Well, I'm going to judge you at the end of the week, so if you don't do it, I'll…"  
Dr. Mike Patrick: I'll give you an extra point if you…
Dr. Emily Stuart: Right. So, yeah, I work a lot with gymnasts and the judging is great. It's fun to kind of help kids and sometimes make them cry, but try not to. 
Dr. Mike Patrick: Yeah Yeah. 
Dr. Emily Stuart: I usually help them and help them become better gymnasts. And then, if they do, unfortunately get injured, help them recover. 
Dr. Mike Patrick:  So you can make kids cry both in clinic and when you're judging. 
Dr. Emily Stuart: I do. Unfortunately, yes. 
Dr. Mike Patrick: That must be very satisfying having been a gymnast too. 
Dr. Emily Stuart: Yes. Yes, and so I, like I said, had a spondy, and I had to give up my sport because I have listhesis. And so it's a way for me to kind of give back to my sport and stay involved in the sport. 
Dr. Mike Patrick: That's great. 
Dr. Eric Bowman: And I would… So sorry, I want to throw in, she's really involved. I want to give a kudos to Dr. Stuart in the fact that she's been invited to National Gymnastics Meeting later this summer to speak and everything on the injuries and whatnot. 
Dr. Emily Stuart:  Yeah, I'm going to speak on actually back pain in gymnasts at the USA Gymnastics Congress. 
Dr. Mike Patrick: That's fantastic. 

All right. So there's going to be a bunch of links that folks can find if you head to and look for Episode 316. We'll have links to the Sports Medicine Program here at Nationwide Children's. We'll also have a link to the Osteopathic Manipulation Clinic. We're going to get some information squared away on that, and then we'll put a link once we have the correct information online for folks. 
I'll have a link to scoliosis episode that we did with Dr. Beebe. That will be there. And then also the link on finding a DO with the Osteopath… You'll let me know after we're done recording.  
Dr. Kimberly Wolf: Yes. 
Dr. Mike Patrick: We'll figure out that so people can find a DO easily if you're in other parts of the country. And then, also the American Academy of Orthopedic Surgeons, the Pediatric Orthopedic Society of North America and the Scoliosis Research Society. All of these places, if you want more information on these things, are fantastic sites with lots of information, not only for clinicians, but also for parents as well. 

All right, I think that we've had a successful first launch of this concept of having a co-host. What do you…

Dr. Eric Bowman: I think it's been great. I think it's been really fun and, you know, I'm really excited to get back pain and osteopathy out there. So it's been really good. 
Dr. Mike Patrick: And I'll put a plug in if there're any other folks out there listening who are affiliated with Nationwide Children's that would like to do a similar sort of thing in your specialty, just let me know. 
I think this is going to work well to get information out for folks. 
All right. let's take a quick break and I will be back. We'll wrap up the show right after this. 
Dr. Mike Patrick: All right, I also want to thank each and everyone of you for taking time out of your day to make PediaCast a part of it. Really do appreciate that.  
That is all the time we have. PediaCast is a production of Nationwide Children's Hospital. Don't forget, you can find PediaCast in all sorts of places. We're on iTunes and most podcasting apps for iPhone and Android, including the Apple podcast app, Downcast, iCatcher, Pod Bay, Stitcher and TuneIn.  
We're also on iHeart Radio, where we not only have this program. We also have PediaBytes, B-Y-T-E-S, and those are shorter clips from this show. They can be weaved together with other content providers to make your own custom talk radio station  on iHeart Radio, so be sure to check those out. 
And then, there's the landing site,, where you'll find an archive featuring hundreds of past episodes, transcripts of each program in case reading suits your taste, and handy contact page to ask questions and suggest show topics. 

We also have a voice line if you'd rather phone in your question or comment and the number there is 347-404-KIDS, 347-404-5437. 
We're also on Facebook, Twitter, Google Plus and Pinterest. And you know, we have lots of great content in those places so you can share with your own online audience.  

And, of course, we always appreciate you talking us up with your family, friends, neighbors and co-workers, anyone with kids or those who take care of children, including your child's health care provider. 
Next time you're in for a sick office visit or a well-check up or sports physical, or a medicine recheck, whatever the occasion, let them know you found an evidence-based pediatric podcast for moms and dads. We've been around for nearly a decade. Lots of great content, deep enough to be helpful, but in language parents can understand. 
And, while you have your providers' ear, let them know we have a podcast for them as well, PediaCast CME. Similar to this program. We turn up the science a couple notches and provide free Category 1 CME credit for listening. Shows and details are available at 
All right, this one is in the can. We made history today. Hope you found it useful. 

And until next time, this is Dr. Mike, saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.  


Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast. 

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