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THIS Overlooked Spine Problem Can Trigger Back Pain After Menopause · Scoliosis with Dr. Chris Gubbels

• 0:00
  SPEAKER_00: If you've been treated for back pain since the onset of menopause, and it keeps coming back no matter what you try, there's one overlook cause that may have never been checked, and that's scoliosis.
• 0:11
  SPEAKER_00: It frequently gets missed because on an MRI, it's not what they're really looking for.
• 0:15
  SPEAKER_00: They may find arthritis, go warnod disc, zoonosis, or even a pinched nerve.
• 0:20
  SPEAKER_00: Now those findings are real, but they don't always explain why your pain keeps coming back, especially if your pain got worse during or after the onset of menopause.
• 0:30
  SPEAKER_00: Hi, I'm Dr.
• 0:31
  SPEAKER_00: Chris Goodwolz, and I specialize in the non-surgical treatment of scoliosis and hyperkyphosis.
• 0:36
  SPEAKER_00: And I'm going to show you why scoliosis is often missed in women with back pain after the onset of menopause.
• 0:43
  SPEAKER_00: I'm going to show you how to find out if you have it and how that diagnosis can actually change or should change your treatment plan.
• 0:50
  SPEAKER_00: Now, a lot of women come into my office after already spent years of treating their back pain with other modalities.
• 0:56
  SPEAKER_00: They've done things like physical therapy, joint injections, chiropractic care massage, and frequently many different types of pain medications.
• 1:04
  SPEAKER_00: They may have felt better for a few weeks, maybe even a few months, but eventually the pain returns.
• 1:11
  SPEAKER_00: And when that continues to happen, I start to look for and ask different questions.
• 1:15
  SPEAKER_00: Why does the same part of the spine or back keep getting irritated?
• 1:19
  SPEAKER_00: You see, most women with adult scoliosis do not go to their doctor because they think their spine is curved.
• 1:25
  SPEAKER_00: They go because their lower back hurts, or because they cannot get up and stand and walk as long as they used to be able to.
• 1:32
  SPEAKER_00: Doing simple things like walking through a grocery store completely wears them down.
• 1:36
  SPEAKER_00: They may start to feel pain in their hips or down their legs.
• 1:39
  SPEAKER_00: They feel stiff when they get out of bed in the morning.
• 1:42
  SPEAKER_00: They may notice they're starting to lean or tilt to the side or start to lean and hunch forward, but they just contribute at the bad posture or getting older.
• 1:50
  SPEAKER_00: So eventually the areas that are causing pain start to get examined.
• 1:54
  SPEAKER_00: An MRI may show that our disc is worn out, there's arthritis, narrowing around the nerve opening, narrowing a compression on the nerve, which is called stenosis, possibly disc bulge, maybe even a disc herniation.
• 2:05
  SPEAKER_00: And again, those findings are real, but they don't tell you the whole picture what's possibly going on.
• 2:11
  SPEAKER_00: Another thing is an MRI is generally a section of the spine.
• 2:14
  SPEAKER_00: It doesn't tell you the whole picture because it's not weight bearing, and it doesn't always tell us why that section is wearing down faster than the other side.
• 2:24
  SPEAKER_00: Think about a tire that's wearing out unevenly.
• 2:26
  SPEAKER_00: Even if you replace the tires, those tires keep losing tread on one of the edges.
• 2:31
  SPEAKER_00: And that worn tread is real.
• 2:33
  SPEAKER_00: You can see it and you can measure it.
• 2:35
  SPEAKER_00: You can replace the tire, you can patch it, you can rotate it.
• 2:38
  SPEAKER_00: But if the car is out of alignment, you're gonna keep chewing through that same side of the tire.
• 2:43
  SPEAKER_00: And that's exactly what can happen to the spine.
• 2:46
  SPEAKER_00: You see, if the spine starts to lean or rotate, your body weight no longer travels evenly through the disc and the spinal joints.
• 2:53
  SPEAKER_00: One side takes the round of pressure.
• 2:56
  SPEAKER_00: The disc on that side may lose their height faster, the joints on that side may become more irritated, the muscles have to work overtime just to try to keep your body upright.
• 3:04
  SPEAKER_00: So the MRI correctly identified the worn disc.
• 3:07
  SPEAKER_00: It may correctly identify the arthritic joints.
• 3:10
  SPEAKER_00: But what it may not show is an accurate assessment of the alignment problem that keeps putting extra pressure on that area.
• 3:17
  SPEAKER_00: You see, the MRI shows us that worn tread, but a standing full spine X-ray can help us see the actual alignment problem, why the spine is wearing out unevenly.
• 3:28
  SPEAKER_00: And this is where menopause becomes really important.
• 3:31
  SPEAKER_00: You see, you don't have to have scoliosis as a child to develop it later on in life.
• 3:35
  SPEAKER_00: Now there are two common patterns that we see with adults with scoliosis.
• 3:39
  SPEAKER_00: Some of them had a curve when they were younger.
• 3:41
  SPEAKER_00: Maybe they knew about it, or maybe they didn't.
• 3:44
  SPEAKER_00: Maybe it was actually too small to treat or wasn't a concern.
• 3:47
  SPEAKER_00: Or maybe they never even knew it was there.
• 3:49
  SPEAKER_00: Those curves can continue to progress in adulthood and become more painful and less stable as the spine changes as we age.
• 3:57
  SPEAKER_00: In fact, 68% of all adolescent scoliosis continues to progress in adulthood.
• 4:04
  SPEAKER_00: But other women develop a new scoliosis during adulthood.
• 4:08
  SPEAKER_00: We call that an adult de novodegenerative scoliosis.
• 4:12
  SPEAKER_00: De novo just means new.
• 4:14
  SPEAKER_00: So we have a new scoliosis that actually developed in adulthood.
• 4:19
  SPEAKER_00: It was not necessarily a childhood curve that somebody missed.
• 4:22
  SPEAKER_00: It's something that started as an adult.
• 4:25
  SPEAKER_00: Now, when we look at this, this typically develops to a woman around the age of 50 or with the onset of menopause.
• 4:32
  SPEAKER_00: This can also develop in men, but in men it frequently develops later on in the late 60s or early 70s.
• 4:38
  SPEAKER_00: Now, research has actually found that degeneration of disc and the facet joints of the lower back can increase or accelerate after the onset of menopause.
• 4:47
  SPEAKER_00: So aging is definitely part of the picture.
• 4:50
  SPEAKER_00: And the hormonal changes after menopause absolutely contribute.
• 4:55
  SPEAKER_00: See, during menopause, bones tend to become less dense with the onset of osteopenia or osteoporosis.
• 5:02
  SPEAKER_00: And the ligaments that hold their spinal joints together tend to become more relaxed.
• 5:06
  SPEAKER_00: So the spine loses some of its natural stability.
• 5:08
  SPEAKER_00: Now, here's why that really matters.
• 5:10
  SPEAKER_00: The disc and the facet joints don't always wear down evenly.
• 5:14
  SPEAKER_00: One side where the disc may lose their height faster than the other side.
• 5:17
  SPEAKER_00: And once that happens, the spine begins to tilt to that side.
• 5:21
  SPEAKER_00: And once the spine tilts, gravity puts more pressure on that side of the spine.
• 5:26
  SPEAKER_00: You see, the problem actually starts to feed itself.
• 5:29
  SPEAKER_00: A little more disc collapse, a little more tilt, a little more uneven pressure on that side.
• 5:34
  SPEAKER_00: And over time, the woman is no longer dealing with one worm disc.
• 5:38
  SPEAKER_00: Her spine has actually started to change shape.
• 5:41
  SPEAKER_00: But the first thing she feels is pain.
• 5:43
  SPEAKER_00: So that is what everyone tends to treat.
• 5:45
  SPEAKER_00: It's actually the number one reason adults seek treatment for scoliosis is they're dealing with pain, it starts to negatively impact the quality of life.
• 5:53
  SPEAKER_00: And that's how a curve can go undiagnosed for years.
• 5:56
  SPEAKER_00: It's very common for a woman to read her late 50s or 60s and start having more trouble with her back pain.
• 6:03
  SPEAKER_00: And then it's shocking when someone actually tells her, you know, you actually have scoliosis.
• 6:08
  SPEAKER_00: At that point, the next question is simple.
• 6:11
  SPEAKER_00: Has anyone actually ever looked at the whole spine while you're standing up from the front and from the side?
• 6:17
  SPEAKER_00: You see, standing matters because scoliosis as an adult is a gravitational problem.
• 6:23
  SPEAKER_00: You are literally at war or at tug of war with gravity.
• 6:26
  SPEAKER_00: And as we age, we tend to lose that war little by little.
• 6:31
  SPEAKER_00: So gravity is the actual force that drives or propels scoliosis forward as we break down degenerate as an adult.
• 6:40
  SPEAKER_00: An MRI is excellent looking at disc and nerves and the spinal canal, but you're usually lying down when you do x-rays.
• 6:47
  SPEAKER_00: And it doesn't always show your head, your rib cage, your spine, and your pelvis and how they line up overall when you're on your feet.
• 6:55
  SPEAKER_00: It's really only focused on one section of your spine in a non-weight-bearing position.
• 7:00
  SPEAKER_00: On a full spine X-ray, we measure the curve using something called the cob angle.
• 7:05
  SPEAKER_00: Now, the cob angle is simply a method that's used to measure the severity of scoliosis curves.
• 7:11
  SPEAKER_00: And how that's done is you draw a line along the most tilted bone on the top and the most tilted bone on the bottom, and where those intersect, you can measure that angle, and that gives us the cob angle, which is basically how we determine the severity of your scoliosis.
• 7:24
  SPEAKER_00: So look at your imaging report.
• 7:26
  SPEAKER_00: Doesn't mention scoliosis, doesn't mention a spinal curve, doesn't mention a cob angle, any leaning or imbalances.
• 7:34
  SPEAKER_00: Now, if none of those words appear, that doesn't prove we don't have scoliosis.
• 7:39
  SPEAKER_00: It may mean the imaging was taken for a different reason and nobody was actually looking at the full shape of your spine.
• 7:45
  SPEAKER_00: Now, many MRIs that I see do mention when people have scoliosis.
• 7:50
  SPEAKER_00: Most of the time they don't measure the severity of the curve and they almost never have the actual degrees because MRIs are not designed to measure scoliosis and it's not the best tool to measure scoliosis.
• 8:02
  SPEAKER_00: So if you're finding this information valuable, be sure to hit that subscribe button for more content on how to get out of constant back pain, especially when your current treatments have at work.
• 8:12
  SPEAKER_00: And hit that bell icon so you're notified when we release new content.
• 8:17
  SPEAKER_00: Now, what happens if we do find scoliosis on an X-ray?
• 8:21
  SPEAKER_00: Well, it really depends.
• 8:22
  SPEAKER_00: Two women can have a 30-degree curve and live completely different lives.
• 8:26
  SPEAKER_00: One may still be really active and balanced and able to walk for over an hour.
• 8:30
  SPEAKER_00: The other may be leaning to one side and starting to bend or hunch forward and have to sit down after just a few minutes of standing.
• 8:37
  SPEAKER_00: They could have the exact same number or the exact same degree of scoliosis, but they can be a very different problem.
• 8:44
  SPEAKER_00: That's because the severity of the curve is not the best indicator of what someone's actual pain levels are.
• 8:51
  SPEAKER_00: You can have a small curve and be in a lot of pain.
• 8:54
  SPEAKER_00: And you may have a large curve and actually have minimal pain.
• 8:57
  SPEAKER_00: There are other things we look for that are better predictors of pain and how that pain impacts one's quality of life, which is called health-related quality of life.
• 9:07
  SPEAKER_00: So once I see a scoliosis curve on an X-ray, I want to know three things.
• 9:12
  SPEAKER_00: One, is it changing?
• 9:13
  SPEAKER_00: Do we have any prior x-rays that show a history of spine progression?
• 9:18
  SPEAKER_00: Different scoliotic curves progress at different rates, but a history of progression is the best predictor of future progression.
• 9:25
  SPEAKER_00: Two, is the spine flexible?
• 9:27
  SPEAKER_00: Now we usually identify this by taking lateral bending x-rays to see how much that curve reduces.
• 9:32
  SPEAKER_00: The flexibility of the curve is one of the biggest, if not the biggest, predictor, if we may be able to potentially reduce the size of that curve.
• 9:41
  SPEAKER_00: And three, what is that curve keeping you from doing?
• 9:44
  SPEAKER_00: This is probably the most important thing.
• 9:46
  SPEAKER_00: Now that last question tells me a lot.
• 9:48
  SPEAKER_00: It also tells me what the true or the most important goals are with treatment.
• 9:52
  SPEAKER_00: Maybe you can't stand long enough to cook your dinner.
• 9:54
  SPEAKER_00: Maybe you can't stand long enough to go for a short walk around a block or be able to walk in the grocery store.
• 10:00
  SPEAKER_00: Maybe something that you've been wanting to do your whole life, like travel and go on vacation in your retirements, used to be a dream, but now something you dread or that it seems like it's not attainable because you can't stand and walk and move without having pain.
• 10:14
  SPEAKER_00: Maybe you stop doing things you love, like gardening or exercise.
• 10:18
  SPEAKER_00: Maybe you just go into the grocery store and doing some shopping.
• 10:21
  SPEAKER_00: Used to be something that you enjoyed, and now it's something you dread.
• 10:24
  SPEAKER_00: And if you have grandchildren, maybe you're unable to play with them or help take care of them because of your severe back pain.
• 10:30
  SPEAKER_00: And I want to know those things because our primary goal is to enhance the quality of someone's life.
• 10:36
  SPEAKER_00: Help them be able to things that are the most important and the things they enjoy as long as possible.
• 10:41
  SPEAKER_00: But even then, I'm not just gonna assume the scoliosis is the only reason you hurt.
• 10:46
  SPEAKER_00: The pain may be coming from an actual worn-on eye disc, a compressed joint, an irritated nerve, or several things all at once.
• 10:54
  SPEAKER_00: The important question is whether the scoliosis is contributing to the pressure that keeps irritating the nerves.
• 11:00
  SPEAKER_00: Is the scoliosis the underlying cause of those problems?
• 11:04
  SPEAKER_00: Because an injection can actually calm down the joint or nerve by decreasing inflammation temporarily.
• 11:10
  SPEAKER_00: Physical therapy may improve some strength or movement, massage or chiropractic here can help you feel better, move better temporarily, and medication can actually help you function better temporarily, but may have a bunch of other negative side effects.
• 11:24
  SPEAKER_00: But if the spine keeps loading unevenly in the same way, every time you stand or walk because of scoliosis, that pain is going to keep returning.
• 11:33
  SPEAKER_00: This is why finding the curve changes the whole plan.
• 11:37
  SPEAKER_00: We're no longer only asking how do I calm down the place where it hurts.
• 11:41
  SPEAKER_00: We're asking how do we reduce the uneven pressure that keeps making it hurt?
• 11:46
  SPEAKER_00: That may involve scolios-specific rehabilitation, like scolly balance, or custom adult bracing, like the scoli brace, or likely a combination of those treatments based on the initial curve assessment.
• 11:58
  SPEAKER_00: The details depend on the person.
• 12:00
  SPEAKER_00: A flexible curve is different than a rigid one.
• 12:02
  SPEAKER_00: A woman who's still well balanced is different from someone who's collapsed to one side and starting to lean and hunch forward.
• 12:08
  SPEAKER_00: A stable curve is different from one that has clearly shown progression over the years.
• 12:13
  SPEAKER_00: But the goal is almost always the same.
• 12:16
  SPEAKER_00: Reduce pain, stop or slow progression, and improve fection and enhance quality of life.
• 12:21
  SPEAKER_00: And overall, to help that person keep doing the thing, scoliosis has started to take away.
• 12:26
  SPEAKER_00: Now, that doesn't always mean making the spine perfectly straight or reducing the curves.
• 12:30
  SPEAKER_00: For adults, especially older adults, success may be being able to stand longer, walk further, needing less medications, feeling more stable, getting through the day without organizing every single thing you do around your back pain.
• 12:45
  SPEAKER_00: So if your pain began after menopause or has become harder to control since then, do not assume you absolutely have scoliosis, but find out whether anyone has actually checked.
• 12:55
  SPEAKER_00: Start with any images you already have.
• 12:58
  SPEAKER_00: Look for the word scoliosis, spinal curve, cob angle.
• 13:01
  SPEAKER_00: Then ask or look for if those images showed your entire spine while you were standing, both from the front and from the side.
• 13:09
  SPEAKER_00: And ask one direct question.
• 13:11
  SPEAKER_00: Could scoliosis curb or spinal imbalances contributing to why that same part of my back pain keeps wearing down and hurting?
• 13:18
  SPEAKER_00: Yes, you may absolutely have arthritis, you may have disc degeneration or stenosis.
• 13:24
  SPEAKER_00: But if your spine is leaning and loading those areas unevenly, that changes what needs to actually be treated.
• 13:30
  SPEAKER_00: And until someone actually checks for that, you may keep getting good treatment, but only for part of the problem.
• 13:36
  SPEAKER_00: Now, once scoliosis is found, the next question is what can you do about it without jumping straight to surgery?
• 13:43
  SPEAKER_00: I have another video that walks through the top non surgical treatments for adults with scoliosis and how each one may be appropriate for you.
• 13:51
  SPEAKER_00: You can watch that video here or by clicking on the link in the description.
• 13:55
  SPEAKER_00: I'll see you there.