Behind The Brace Podcast

About Behind The Brace Podcast

2025 Update: New Episodes Available Now! Hosted by Dr. Mandy Dietz, the Behind The Brace Podcast is a place for conversations and resources to help families and providers navigate the world of scoliosis. This is your place to find hope for a better solution so that you can live your best life.

Publisher

Dr. Mandy Dietz

Category

health & fitness

Language

en

Explicit

No

First episode

29 Jun 2021

Latest episode

21 Oct 2025

Latest episodes

56 episodes in the feed.

1. 

   21 Oct 2025

   Season 1: Episode 14 - Exciting Update! We Are Opening A ScoliCare® Clinic in North Dakota

   In this episode, Dr. Mandy shares some exciting news about her clinic and the new resources coming to the North Dakota area. Listen in to find out helpful tips and be sure to check out the links below for more information! *****Resource Links You Need: Contact Dr. Mandy's office to learn how to work with her by calling (701) 223-8413 or email her at info@drmandychiro.com (mailto:info@drmandychiro.com). Free Online Screening Tool: https://app.scoliscreen.com/ (https://app.scoliscreen.com/) Find out more about ScoliBalance® at https://scolicare.com/patients-scolibalance (https://scolicare.com/patients-scolibalance). Find out more about ScoliBrace® at https://scolibrace.com (https://scolibrace.com/). *****Transcript***** Hi, I'm Dr. Mandy Dietz and you're listening to The Behind the Brace podcast. Each week I'll be sharing conversations and resources to help families and providers navigate the world of scoliosis. This is your place to find hope for a better solution so that you can live your best life. Welcome back. This is the last episode of the season and I have some really exciting news for you guys. I actually am not really sure who knows and who doesn't know because we've been working on this for quite a long time and I know that we have shared on social media some of the updates in the news with our clinic, but I really wanted to officially let you know that we're taking a break, mostly because as we move into this fall and through the holidays, that we are opening a ScoliCare® clinic here in the state of North Dakota. And so, that's actually really exciting. And what that means is, as you all know, I've been doing this work for over a decade and we've been using ScoliBrace®, we've been adding new tools, we've added ScoliBalance®, we've done more trainings. But this is different because this is an official ScoliCare® clinic here in our state, in our rural community, which is a huge asset to our families and our patients. And it really allows us to focus more fully on more specialized care and to be able to bring more trainings, more people in, more rehab therapists, and to be able to reach more people and do more with the tools that we, that we have and that we've been working on. So I wanted to let you know, because there's gonna be some changes as we move, uh, through this next couple of months and into the holidays. So what that's going to look like is right now I am in my current clinic. You guys will still come to the normal space and we'll still be seeing you as we always do, and we'll actually be opening the ScoliCare® Clinic in a new space. So our friends over at Jones Physical Therapy are expanding and they're building a new building. And that's amazing. And we're so excited for them. And what's really fun about it is that in conversation, that space kind of came into our circle and we're actually going to be moving into that space as they move out of that space which is just a blessing to us, honestly, because, Dr. Liz Jones has been such a friend to us and we've coordinated together in the community, and as they move forward and they are growing, we get to move into their space as a ScoliCare® clinic. And I really just couldn't be more excited for that. So that will look like the end of the year. So as we're going through Thanksgiving and into the Christmas season, the ScoliCare® Clinic will be being built in that space. And then come January 1st, we'll be starting to function out of that space. So in the new year, you'll have to look, um, to our website, into our podcast. We'll have the address, the details, the location. So if you're a scoliosis patient of ours, you'll be seeing me out of that office in 2026, which honestly seems a little crazy to say that out loud because I don't know where this year went. And then even more exciting as we move into the new year. We've got a team of people coming over, uh, from Australia that are going to be doing some intensive trainings with us and some new staff members that we're going to be bringing on. We'll have some additional rehab therapists that are going to be coming in to give some help with some ScoliBalance® tools to our patients, as well as some new staff at the front desk. So you'll be seeing some, new faces and meeting some new people. And then our plan is that as they come over and we do these trainings, um, we get into February. At the end of February, we're going to do a really big celebration at the new clinic and invite our community and other providers and our patients into the space so that you can see it, you can take a look at it, you can see all the cool new things that we're doing. It's gonna look different than the office that we have right now and be more functional and have just a lot more to offer you. And so, we'll have the ability to open up that space as well so we can offer some trainings to other people in the community and work with other providers. So there's just a lot of really cool, exciting things that I've been waiting to share until we had some more details. And so as we move into this break, we'll have additional resources that we're going to link. Like on our social media. So as always, we've got a ton of different podcasts and topics, and so we'll be circling those back a little bit, uh, as you go into the next couple of months so you can still jump on and get information and find the things that you need. And of course, you know, as, as we've talked about before, our goal is really to partner with people in the community and to be able to give some information, uh, to families when they're looking. So we always offer a discovery call. So if you are either a provider or a patient who's wondering if our office can help you, we offer a 15 minute call where we jump on. We can even look at some of your images and talk through the situation just to see if it's something that is appropriate for our office or if we can direct you somewhere else. So in the meantime, if you're not hearing from us regularly. If you are looking for those resources, all you have to do is jump onto our social media or our website, shoot us an email or even a text message to our office, and we can help you get that scheduled. Also you can email information over to us as well if you're looking for some input on that. We always love to help with those scenarios. Um, so as we go, please be watching. We'll have an updated website as well. So, new websites, new, uh, location, new address, new faces, new people, lots of really big exciting things. There'll definitely be a little bit of a transition as we're moving from one clinic to the next. And of course we'll make sure that we're sending that information out to you. So if you are someone who is in our office regularly. Don't worry about that, you'll have the information at hand. If you're somebody that's new here and you are just finding our podcast for the first time feel free to go back to some of our earlier episodes this season. We've got some really great content. Um, the last week we had Dr. Tara Harding on our podcast and we were able to talk through a lot of different things, regarding hormones and testing and local options that we have. So many things that you can go back and, and just take a peek at while you're waiting for us to come back early next year. So if you need us, you know where to find us. Hope you guys all have a fantastic holiday and we'll see you next year. Thanks for spending time with me today. If you could leave a review before you go, that would help us reach more people that need this message. To learn more about the services and resources that we have available, visit us at behindthebrace.com. This show is produced by RAYMA Team Media. To learn more about how they can help you with your podcast, visit raymateam.com.

2. 

   7 Oct 2025

   Season 1: Episode 13 - The Effect of Hormones on Scoliosis with Dr. Tara Harding

   In this episode, Dr. Mandy has a conversation with her friend, Dr. Tara Harding, on the effect of hormones on scoliosis and what patients need to consider when looking for answers on the internet. This is a MUST LISTEN TO episode for parents of teens, teens, and women in your 20's, 30's, 40's and beyond. Listen in to find out helpful tips and be sure to check out the links below for more information! Dr. Tara Harding is the owner of Simply You Wellness and an experienced doctorate family nurse practitioner and fertility coach with patients worldwide. She received her master’s and doctorate degree from George Washington University and has received an additional certification through the American Society of Reproductive Medicine (ASRM) and Marquette Method Certified. After facing personal health challenges, she decided to leverage her experience and knowledge to help individuals and families improve their health and wellness. As a result,she created a unique approach to healthcare at Simply You Wellness. Dr. Tara empowers her patients to understand and take control of their health while being a partner in their health journey, supporting them as they navigate the path to optimal health and well-being. Connect with Dr. Tara at simplyyouclinic.com (https://simplyyouclinic.com/) and subscribe to her podcast, Hopeful Hints, at https://simplyyouclinic.com/podcast/ (https://simplyyouclinic.com/podcast/) or on Apple Podcasts and Spotify. *****Resource Links You Need: Contact Dr. Mandy's office to learn how to work with her by calling (701) 223-8413 or email her at info@drmandychiro.com (mailto:info@drmandychiro.com). Free Online Screening Tool: https://app.scoliscreen.com/ (https://app.scoliscreen.com/) Find out more about ScoliBalance® at https://scolicare.com/patients-scolibalance (https://scolicare.com/patients-scolibalance). Find out more about ScoliBrace® at https://scolibrace.com (https://scolibrace.com/). *****Transcript***** Hi, I'm Dr. Mandy Dietz and you're listening to The Behind the Brace podcast. Each week I'll be sharing conversations and resources to help families and providers navigate the world of scoliosis. This is your place to find hope for a better solution so that you can live your best life. Welcome back. This week we have a guest on our podcast that I'm super excited to introduce. Today we have Dr. Tara Harding, the founder of Simple You Wellness. She's a doctorate prepared family nurse practitioner that specializes in hormone health for men, women and children, and integrative women's care. She's passionate about helping patients move beyond being told everything is normal, and instead uncover the root causes of symptoms like fatigue, weight changes, mood swings, and cycle irregularities. She brings extensive clinical experience, a personalized approach, and a shared dedication to helping patients feel like themselves Again, her clinic is leading the way in transforming how hormone health is addressed, and she empowers patients to be heard, understood, and truly cared for. Welcome. Hey, thank you. Yes, thanks for coming on today. So I'm super excited to have you here because there's a big conversation happening in the scoliosis world that it doesn't have a ton of research behind it, but we know that it's affecting patients that have scoliosis. And as I do more of this work, I've got patients that come in my office, they have questions, and it's not within my, it's not within my specialty. Specialty. Yes, yes. And I know about it, but it's not something that I have dedicated my career too. Right? So, this is within your wheelhouse. Yeah. So thanks for coming on. Yeah. You know, I'd like to just shout out patients, right? Like, I think sometimes patients have to get a degree. You know, we always joke about Dr. Google, but what do patients do when they're left with no answers? You go to one side of medicine and they're told. Everything's fine. Nothing to do here. You can't fix that. You can't change that. That won't help that. That's not FDA approved. And then you go to the other side of the spectrum and it's like, here, take a bazillion things. I'm gonna cure you overnight and give me this timeframe, this money and everything will be fixed. Right? So patients are really put in a hard spot. From every avenue of healthcare, whether they're young adolescents, um, young women, young men, I mean, really. We could go on and on about that, but it's really hard when you're met with a diagnosis and you get a diagnosis, right, such as scoliosis. Mm-hmm. And it's like, now what? Yeah. Now what do we do? What do we do here now? No, it's hard. Um, in the conversations that I have with patients. You know? Okay. So we all probably do it, even though we say don't do it. But you get a diagnosis and what do you do? You Google it. I encourage it. Right, right. I'm gonna say it. I encourage it. Let's go to the socials. Go. There's great content out there nowadays, right? From good resources and bad resources, but there's a lot out there. Yeah. You have to discern the difference. You do, right? You do. So if you have a hard time discerning the difference between resources that are Yeah. Reputable and resources that are not, sometimes you fall in this crack that can be pretty dangerous. Very. And expensive. And expensive and waste a lot of time. Yep. Actually, so, so that's really, that's why I wanted to have you on and talk about this today, because what I'm finding is, um, so there's this piece of it where patients come in, they're diagnosed with the scoliosis, whether they're a juvenile, adolescent, their kids, right. They're growing, or maybe even they're adults and they've had scoliosis for a really long time. And they find all of this information, and we do know that there are certain things that come along with that diagnosis. Like for example, just like a quick rundown, right? So we know that kids that are diagnosed with scoliosis, it typically, uh, it tends to show up between the ages of 10 and 14. It's typically right before or during puberty. There are a lot of changes going on. We know there are some link to hormones, but. We haven't, nobody's been able to really nail it down. Yeah, exactly. We know that oftentimes there are other things that are, that affect that, whether that's like vitamin D levels or sometimes, um, people have been talking, they'll come in and they'll talk about, um, copper levels that are too high or they'll talk about, um, just a lot of different things that we know that oftentimes those patients might struggle with. But at the same time, there's not really anything in the research or in the science piece of it to say. You know, okay. Like if you have this problem, like say you have this hormone problem or this vitamin D or whatever it might be. We don't know that that for sure makes you have scoliosis, but we do know that patients that have scoliosis oftentimes have those things that are problems. Yeah. So then what do we do with that? Well, if we had a magic wand, we'd have better research and funding for research. Right, right. So we can't, patients have to be very careful about where they're getting their information from. Like you said, is it research back? Like what is there to show that this claim is going to work? What we do know, as you mentioned, some very key times, 10 to 14 puberty. Hormones are rapidly changing during that time. Nutrients, vitamins, supplements, rapidly changing during that time. So it would make sense that bone formation situations would arise during that time. Right. And genetics, mm-hmm. Go hand in hand. So not everyone has information of their genetics, but if you do, it's again looking at is there someone in the family that has this diagnosis or other hormonal issues as they progressed in life? And looking back on that. Estrogen, testosterone, thyroid, insulin, cortisol. When people hear hormones, they think like estrogen, like that's the first thing that comes to their head. Maybe progesterone, maybe testosterone. We're lucky. Thyroid, insulin, cortisol. There's all these different hormones and most we're lucky if we, if patients come in and they've had one or two looked at, never is the full picture being looked at. Then we look at iron, nutrients, vitamin D, magnesium. Let's not forget about gut. You can take all the things in the world, all of the, whether it's even in a prescription or a supplement, and if your gut health isn't working or not on point, how are you gonna absorb all of that? And is there an absorption issue that's, you know, tailing back to some of these things too. People forget. Providers, let's just say providers sometimes forget to look at the whole picture and that pivotal time where you're seeing this happen, there is a cascade, rapid cascade of things going on that we could interject and help with. We have to look at them as a whole picture though, right? We have to do the appropriate workup. These, these children aren't getting in a workup. They're going in. Bringing forward maybe a symptom or a concern and it's being dismissed, or they're not even getting adequate lab levels drawn to look at vitamin D levels, look at nutrient levels, look at their hormones, talk about their periods if they're a female, right? Like these things just aren't happening, so how can we intervene appropriately to help maybe slow down that process or intervene in that process if they're not even getting a full workup. The conversation's even happening at their provider's office to offer that as an option too. And the other piece of that too, is that sometimes it's the other way where, you know, maybe they go to a medical provider and they're not getting the workup, so then they're not doing anything. But I've also had families where they go somewhere and sometimes it's states away. Right. So we're in North Dakota. Yeah, we're rural, right. That we don't have access to a ton of things, but sometimes I've heard where they go to a facility. They get zero workup, but they get handed a box of whatever supplements or this or that, and it's, you know, $900 a month and woo. Red flakes. You know what I mean though? Yeah. So then they're just taking things, and maybe it's not harmful to them necessarily, but at the same time, is it addressing what is actually needing to be addressed? Like are we wasting time, resources, money, traveling on things that maybe we don't need that specific piece? So how do we test so we actually know specifically what one patient needs compared to the other patient, so that we're actually doing. What's best for them in that scenario at that time. So, oh my gosh, I got cringey when you were saying all that. So let's back it up. The thing I'll hear too is like, you are too young, so let's just talk about adolescents for now. You are never too young for a workup. Like it's never too young to look at your thyroid, your vitamin D, your PCOS, and IH like we're never too young to start looking at these things. I don't believe you should be taking something unless you know your body needs it. That to me is so much red flag right there. Like that seems, I don't know. Can I just say like a money making, like red flag? Money making red flag right there. But let's back up even further. Like we talked about, patients are so desperate, like right, they want to just get answers, they wanna feel better, they'll do anything. It's just a supplement, right? What's the big deal? What's the big deal with that? The big deals if you don't need it, it could spiral into something more further, like maybe not necessarily bone health, but you might get some other symptoms or things that are a direct sub. Supplements aren't necessarily a hundred percent safe if you don't need them either, right? I use this example's not for pediatrics, but there's an over the counter, um, hormone supplement, DHEA. If you take that and don't need that, dear Lord, things will happen. But let's talk about the financials of that, right. What if you could do a home test from your home? You don't need to travel for that. There's a lot of home test things available nowadays where patients can take the control right into their hands themself from the comfort of their home, and do some basic testing. Take that information into a provider and say, help me interpret this and help me navigate what my results show. I don't think you should be just taking a supplement. 'cause it's supplement and it's safe and it's been, you know, marketed by a, b, and C for, it'll, it'll fix this in a direct time. That seems like scary, bad marketing. Right? But, but I wanna validate to patients too, like, you're desperate. Like you're, you want, you want to feel better or you wanna do good for your, your children and you'll do anything for them, right. Grow a team. This is where the team approach has to come into place and not relying on one person. You have to have a whole team taking care of you or your children. Especially in cases like with scoliosis, we have to have a team. We cannot rely on one person with great marketing. It sounds like good props to them, but like we have to have a whole team approach and not rely on one person, one magic box, one magic kit, one magic way. The body is a very intricate system. The head's not rolling around over here to the spine, over here, to the toes over here. We have to work together as a team to look at that whole body of what's going on during that time. It's really interesting too, because we talk about team approach a lot, like on, on this podcast. Mm-hmm. We've talked about it a lot, but the thing that this hit my radar actually just recently this year, because the team that we usually talk about is we're talking about like a spinal specialist. So whether they're. They have a brace at our, our office, or they're doing scoliosis rehab at our office. Or maybe we've got an orthopedic surgeon on board or a neurosurgeon on board if we've got neuromuscular stuff going on, right? And we talk about mental health, so we talk about counselors and how do we process this and how do we do this? And you know, just all of these things. Um. But I didn't really realize, or maybe it was in my head, and I just didn't realize how apparent it was until I started having these families coming in. And then they're talking about this piece where, you know, they'll go to the pe, their pediatrician, and they're kind of just left with. You know, well let them deal with the spinal stuff and you know, their well-check is good, so don't worry about that piece of it. And then they're kind of left with not a ton of resources and they, they feel a little uneasy, but they really don't know what to do. And so I hear you talk about like, okay, we can take these tests from home. And then I have people say like, okay, we can take these tests from home. They're like, we don't know what tests to do. Yeah. We don't know. How do we order that? What do we, and then they, they get overwhelmed. Yeah. And then, and then they see this, um. This something online. Yep, yep. That offers them something and it might be a very long distance away, and it might be this very involved process and they see that and it appears as though it's the answer, but then it's also missing a ton of pieces and they don't get that coordination of care necessarily with their team. So that's why I'm so excited. That you are here. I was gonna say, maybe we should just slip in a hormone expert into this team at this, this point. We'll take care of the testing. Don't do that on your own anymore. Like Right. God, her those days. But like bring it in if you have one. And that's what's so exciting about having you here with your clinic because you guys. Touch a lot of different pieces. Yeah. And can be that other piece of it to really make a cohesive team. Absolutely. We're I just, I don't know. We blend eastern and western, we believe in both sides. We believe the patient, but we believe in extensive additional testing. Right. No matter what age you are, like, I don't care if you're a baby, a lactating mom or a adolescent, like your body is telling you something when symptoms are happening. It, it is your whole body. Every hormones actually impact every organ in your body. That includes tendons, ligaments, bones, like, I mean like everything in our body. So. I often question myself at night when I'm laying awake. Why are providers so hesitant to like acknowledge that or maybe say, Hmm, maybe there's a hormone issue or a thyroid issue going on in this adolescent that we could address and change now and and change the progression of that child's health, overall health, including bones, hormones, impact bone growth information, and osteoblasts and all of that. Like why is that such like a hard thing to understand? It sounds to me like, like hormones have been, you know, excluded from this conversation when they're really, you know, kind of a important part of bone formation. I don't know. So we, we talk about it. Yeah. In a sense of, you know, so we've always kind of known that. So we talk about it in, in two realms really. Yeah. And this is the conversation we have, but we also don't like, we're limited, right. So you can only specialize in one thing. Yeah. Thank you for that, by the way. Right. Because there's some people who think they can do like. 500 things, right? All in one. And really just be a master of none. Just be a master of none. I like that. Like, like stay in your lane please, please. But that's the thing. It's like, so to do a really good job, like at my office, okay, so we work with scoliosis, we work with these patients to do a really good job. And most people who know me locally, I, you know, I was running a chiropractic clinic, I was also doing a scoliosis clinic. And the farther you get into it and the more that you do, you just realize that. You can't do, you can't be good at all of the things. Absolutely. And if you really wanna serve your patients, and if you really want to provide the best care that you can, you just have to dive into the one realm. Right. And then as we come, come back to that, that's where. You know, we find this place where we know, we know that hormones come into this, but the conversation we have is limited because we don't have, we don't have all of the resources or the tools. Yep. So we can tell. Families that we know that during puberty, that's where it's the highest amount of progression happens. So the onset of their menstrual cycle? Yep. Within that first like 18 to 24 months, that's when we see the fastest progression. That's also when kids are growing the fastest and we see the most progression in their scoliosis. But the other piece of it that actually nobody tends to talk about is women. Postmenopausal women. Ooh, perimenopause. Bless the women, right? So if we have, say we've got a scoliosis, and even if it's relatively stable throughout their adult life, when they start to hit menopause, we see fast progression in those patients as well. And then it comes back to that hormone piece. Hormone piece, and it's not very well understood necessarily. And this is where, so from my perspective, I have to say. When we look at a scoliosis patient, we do x-rays, we do very specific exams, we do evaluations. Um, we base our treatment recommendations off of where they're at based off of, um, the clinical guidelines, the research that's provided, evidence-based care. So we are giving those recommendations. It's not this off the cuff. We're just going to wing in Pinterest medicine. That's what I call it. Like everyone thinks I just do Pinterest medicine over here. Yes. I'm like, everything is research based that way. You do. Right. Everything. Uh, but that's the piece where it's like, okay, so for those patients that are looking for this piece, yes. This is where you come in. Yes. And I think you like, bless the pediatricians. There's a time and place for them, but this is hormone health is not their specialty. Right. That's why we have to have patients. Really expand their mindset or the OB GYN and the menopause people. Right? That is not always their, you would think, right? Man, ob, GYN, that's their specialty. It's not, like you said, the, there's just so much going on. There's, it's such a busy field. Keep them, keep these, keep these people on your team, but grow your team to include a true hormone expert that can really dive in. Because menopause is the time where, man, that rapid drop in estrogen, boom, there goes the bone health, right? Mm-hmm. And that's not, it's like, oh, once you're an osteoporosis, that's done. Here's your, here's your, you know, prescription medicine. That won't actually help much here. But, you know, we'll talk hormones, man. Can I just say it like, put someone on estradiol, progesterone, testosterone as a female, and you can really, really stop that progression. You gotta catch it right away. Don't wait till you're, you can still bring it in 10 years later. But what if, what if we had a new way of thinking? What if hormones bioidentical were actually safe and could help preserve bone and preserve our quality of life and not wait till a fracture happens? You know, for that, what if that'd be amazing. And I, there's, there's research, like you said, everything we do is research based. This is not just made up with nothing to back it. And we know too, the two times you're talking about are the most pivotal hormone changes in a woman's life, like the two most pivotal changes. And yes, there is something you can do in those moments to help it. It's not just Yep, not nothing you can do. Here's your birth control. You know, that's what the teens are usually met with. Here's your birth control or nothing. Mm-hmm. And then here's women. Yep. Menopause is just the way it is, you know? May, here's your unopposed estrogen. You know, if you're gonna get estrogens different than Estrodiol, that's a whole different podcast for a different day. But, um, you are given one option at that age and one option at that age, and that's all they know. And so really we are trying to change that at both spectrums in our clinic. And I'll just say there's plenty of evidence to back it can help bone, bone, bone support during that time too. And changing the conversations. Changing the conversations, yes. That we're having. Just even open it up so that we can have those conversations. Yes. Uh, what I see in clinic is, and this is where. This is where we struggle because, uh, what I see in clinic is I have women that come in that either didn't know that they have a, had a scoliosis. Oh. Because think back, okay, so think back 40 years. Like sometimes they, when get diagnosed, you knowm as you say that I'm in my high school locker room getting a scoliosis check from the county health nurse. Yes. Like I can just see it. My, my gym, gym t-shirts off. Bend over. Mm-hmm. Got boom, boom. Done. Check, carry on to Ed. And I'm like, that's it. I thought I could be outta fiad longer here. Right. That's what came to my head as you said that. Do you know they don't even do that anymore? Thank gosh. Thank gosh those are, I actually got sent fun fact I got sent off to the next level. I don't know what that Yeah. To James. You know, I was in a small town. Ashley got sent to Jamestown to, I don't know what, like the higher up, uh, public health nurse. I don't know what she was, but I had to go get a second check 'cause I think she maybe thought I had it to this day. I mean, do I trust her? Maybe I should have you check me. We can. Maybe I still haven't. So that's, that's the hard thing. Okay. Yeah. So I mean, this is a whole nother topic, but, but at the same time, right? So we're not catching it. No. Back then definitely, definitely we struggled, but even now, today, they don't check for it. Oftentimes I've got patients in full braces, like pre-surgical, they go to a sports physical. They don't even. They don't even mention it. Yeah. I worked with healthcare for 10 years, I could say that. Oh my goodness. Yeah. We don't, we don't, but, and, and duck, you know, like not, I really do believe that all healthcare professionals are very well intentioned, blessed. They are, they are. There's so much, there's so much going on. There's so much changing. Right. How do they keep up? I, I don't, that's why I am like. I, I want us all to come together and just say, Hey, you know, I can't keep up with the updated stuff, the research stuff. I can't do it all. You know, here's someone that can do this. Here's someone that can do this. Like, yeah, people, healthcare providers need to change their mindset too, to be more inclusive and be like, Hey, you need a team. I can't do it all for you. Um, why don't you go, I don't know what they do or who they are over there, but you know, go check 'em out. Go, go see, go, see what's going on over there. Take this piece, take this piece and go take this piece from me. Yeah, that's not. A bad thing to say, I can't do it all. You can't. No. You're the first. Like I, it's impossible. It's impossible to do it all like it just is, and I don't want to do it all. And other providers need to change that narrative in their office because it starts there sometimes too. I think that that's true. And oftentimes, um. There's not even sometimes time to have those conversations. No. In those appointments, you don't see 30 people a day in those settings. Like how, how you're in and out and it's a whole thing. That's impossible. Yeah. Um, so what, what ends up happening? We digress a little bit. Yeah. Gross. So, but what ends up, ends up happening is, is oftentimes these women, forties, fifties, yep. Either they didn't know they had a scoliosis or. When they were done growing, they're 18. They're not a pediatric patient anymore. They're like, okay, well you're done growing, so you're good. Don't worry about it. Like you're fine. Um, off you go. And so they never have another evaluation. What we know now is that if you have a scoliosis that is 30 degrees or above, when you are done growing, the likelihood of progression through your adult life is higher up to a a degree per year of life. So if you think about it, so you've got a 35 degree scoliosis. When you're a senior in high school, you never know have another evaluation and all of a sudden you're 47 years old and you're like, man, I don't know where this back pain is coming from. And then they pop into my office. They're like, oh yeah. Well, I had scoliosis when I was a kid. They told me I was done growing. Don't worry about it. And we take an x-ray and now we're looking at a 65 degree scoliosis. And then guess what happens with that? So. And anybody who's dealing with this, they already know what happens. But for people who don't deal with this or question it, what to question it right now, do I Right? They're like, gosh, I don't know. I've never had my scoliosis checked on since I was in the gym locker room. Right? What ends up happening is, so now they've got this 60, 65, sometimes I've had people with like 75 degree thoracic curves and they're in their fifties or sixties. They're having all these problems, they're having pain. They go to the doctor and they say, well, it's not unstable. Surgery is going to be worse for you than not. So, you know, we can try an injection. Is that what they throw out? I dunno. So, well, sometimes a lot. Sometimes they'll say like physical therapy. Yeah. Or sometimes they'll say, you know, something like that. Do your, um, symptom management. If that doesn't work, then they send them to the pain management people. Right. So it's whether it's injections or. You know, pain medication or, um, you know, people who are looking for answers typically that they're doing, like cupping, dry needling, soft wave. Like they go down this hole of whole road, all the things, whole road. Yep. Right. And, and then. Ultimately, like I have these patients line up in my office and they're like, okay, well for the last three years I've been doing dry needling and cupping and PT and soft wave and um, these, uh, b vitamin injections. And I've been doing, you know, like filling in all of these boxes of like just trying to management this because they're not a candidate for surgery. It's not bad enough, but they also can't clean their shower. Oh. Or pick up their grandkids or empty their dishwasher. And typically what happens is we see that like as you go into like perimenopause, menopause, you get this, this big progression. Yep. So like, where's the hormones all time? I'm gonna cringe it over here. Where's the hormones? And that's just, you know, that's the conversation that on my side, I don't have tools for that. So my question to you is, yep. For those patients. What? Do you have an appointment? An appointment@simplyyouclinic.com right? But I wanna know like what's right. What would you tell them? I would tell them that we know from research, right? Like, 'cause that's the thing here, is that when, when those hormone shifts start to change, it impacts your collagen levels, like osteopenia, osteoporosis, that's the diag. That's probably what they're hitting when they see you, right? Yes. And they're told, well, here's your bisphosphonates. Let's look at the research behind those. Let's just drop it there. But there's a rapid change in estrogen, progesterone, even testosterone, women. We need to have more conversations about testosterone. But that breakdown accelerates. What if we could intercept and slow that acceleration and integrate all those things they mentioned. Great. But I was the whole time like you're missing a hormone piece. Perimenopause happens 10 to 15 years before menopause. It's a real thing. Many women are told that that's not a real thing. It's a trending topic and that's not it. Estrogen protects bone density. It keeps your collagen and ligaments flexible. It actually helps modulate inflammation. So we've got to control cortisol during that time too, 'cause that bugger will intercept. And, and cause such chaos in that time too. And then when it, when you have that rapid drop happen and that menopause point too, now the bone thins, now the ligament stiffen and you're, you're probably seeing this in your office, muscle fatigue more easily, like chronic pain. It was better. And now it's flaring, right? Mm-hmm. That's hormones. That is cortisol. That is thyroid, progesterone. Okay. Let's talk. I wonder how people listening are sleeping good at night if we're not sleeping good at night. Mm. Your body's not going into that moment. It needs to recover and heal. There's actually a lot of. Hormone things happening during that time. You're sleeping, you're having dreamland. There's a lot of cool things happening in your body during that time. And if, and recovery happening. And if you are not sleeping, that's not happening. So perimenopause, often progesterone, we can bring in bioidentical progesterone during that time, um, because it also is declining. It's more of a gradual decline during that time too. And it, and we have insomnia during that time, but tissue healing, we know that's very important here is tissue healing. And progesterone is key to tissue healing. Um, when I always tell patients you're not stressed out. Your cortisol though, like, let's talk about what's really happening in that time. The stupid analogy of like the bear Chas ness in the woods. The bear in 2025 is notifications on your phone, the organizations you're involved and the kids, the husband, the spouse, the work, da da da da da da, like social media. It's just forever. You are being like totally lit up. Your body is constantly in a state of hyper awareness and that cortisol is very, I don't know that I've seen somebody when we've tested their cortisol ever be like. Bingo. Spot on here. Nothing to work with with this. So we talk about the three best friends a lot, hormones, insulin, cortisol. I've added in a few more besties on the block. Um, iron deficiency anemia in women. The thyroid like, oh, thyroid level's normal. I've been told my thyroid's normal. I've been told my thyroid's normal. Do you know, you wanna know how many people have normal when they bring those in. Like zero have normal thyroid levels according to our research that we follow in training the thyroid. Especially in this midlife time for women, it, it overlaps with menopausal symptoms, right? Like fatigue, hair loss, weight gain, again, joint pain, flexibility, all that stuff too. But even the slightest imbalance can further muscle weakness and bone changes with the thyroid. So again, it, it's coming back to having somebody who specializes in this area. Do their workup on you. You still get to keep everybody else. We are very, very team orientated. We are never like, oh, get rid of them. You know, like, have somebody else that's has the time, gives you more than 15 minutes in the office, gives you the lab workup that's appropriate to look at these. And really sits and looks at that piece of the puzzle that it sounds is very missing, very much so missing in this area, and not relying on just, you know, wait till it's what, what if we can, you know, treat dysfunction, not disease, like let's stop it at the dysfunctional state and not wait till it hits that disease point, especially in that perimenopause, menopause. There's so many, there's so many things that can be done. And again, we go into vitamin D, that's like we could do a whole podcast from. Mm-hmm. And vitamin D, the ranges even at our local labs are really, really different. Um, many will come and say they were in toxic levels, they stopped taking it, and their levels are like 80 and winter's approaching that is not toxic. That is just not toxic. Um, they're not taking, they're, oh, they're just taking calcium. No vitamin D with it. Um, the protein intake is not high enough. You know, they're, they're hardly getting even half of the protein intake that they in, we're not doing strength training and muscle resistance training, which is hugely researched nowadays to show can really support bone health, right? Like that goes back to bone health. Iron, don't get me started on that. I want everyone to go grab their lab levels if they've ever had iron levels drawn and look at those ranges. It's like six to 300 is literally a ferritin range on there. And if they go in to provider with every symptom of iron deficiency and those levels are not in the red, they are not treated. And that is unacceptable in our eyes. So we are bringing in iron levels and ferritin, looking at the ferritin and the iron. The gut health of that, right? Are you, is your gut healthy enough to take these oral, uh, supplements? Do we have to do some infusions for a hot second before we go back to that? Right? So it's not just one thing when it comes out, it's nutrients, it's gut, it's hormones, it's everything. And that all ties back. I mean, your bones are literally attached to all of this. You don't have to wait till you have a 75 degree. I think that's what you said, angle change, right? Yeah. Like we can do so much. What if you have undiagnosed PCOS? There's, there's diseases that cause hormone disruption from teens through throughout your twenties and thirties too. Like what if we could intervene and control your insulin levels that are creating, um, inflammation? What if we could intervene and control your progesterone? You're not making enough progesterone. You need some extra progesterone in your luteal phase. Like what if we could support that your whole decades before? You, they enter at that perimenopause, menopause and help really intervene and support their body and catch these things sooner instead of having them come in, uh, menopause with these issues. Right. So when you were talking about. The gut health and the supplements. Mm-hmm. So I have this vivid memory, vivid memory from clinic. This was quite a long time ago. Um, we were taking x-rays and I was like, what in the world? What is on these x-rays? Like what is that? Like? I could not quite figure out what was all over this lumbar pelvic x-ray. So I go back, we're just talking to the patient. Um, it was their Centrum supplements. Oh, yes. Like, you know, those enteric coated like, like filler full? Yes. Just full of fillers. Bad. So like literally scattered buying supplements. Yeah, eating them. Passing them Exactly how they ate them. And so we had to have the conversation of like, okay, look at your X-ray, but. The supplements you're taking are coming out exactly how you put them in your body. Like they're doing you no good. Just stop buying them. Yeah. So there's, there's, let's do a PSA hot second on that. Oh boy. Not all supplements are created equal. They actually found supplements on Amazon tested to not even contain, not to throw Amazon on their bus, but like, we're gonna, they're not containing what they're claiming they contain. So working with a provider who actually understand what is, what is a high quality supplement. Vitamin D. C multivitamin. Mm-hmm. Centrum, you made me cringe when you said that. Like, everyone go throw your Centrum away. I don't care. They can contact me. I don't take one for the team. I'll never forget that. Nope, nope. Like that is not, that is, that's been shown to be full of fillers. You can read the back of the label. It's like that is not a high quality supplement. So I think the overwhelm comes for patient. Well, what do I take then? Well, I trust this really good company that's selling me this box of. Amazing supplements that's gonna help me. But do you need all of that? Is that what you need? Is that what you need for everybody? BODY is different. Everyone is so individual, and just like the tides change, so do your hormones. Like you might only need that for so long and not three months, six months, nine months, not 24 months or three years later, you're on the same thing. Like, did you get a recheck? Did you still need that? What happens after programs end? You know, like. Where is that ongoing support once you buy these magical cure all you know, situations. Where what next? What what again, you should, our goal is that you walk away eventually and you're so in tune with your body that you just know when this happens, it's this, when this happens, it's this, or I need to go see them again. I have no clue what's going on. Let's recheck that again and you just kind of change your, your mindset that our bodies are forever changing. You know, stressors happen. Um, you know, college happens for these teens, right? High school happens. College happens. Then they enter the workforce like they're, and then they have a traumatic thing happen. A loss happens. Uh, an illness happens. Like when these things happen, our hormones are changing. So we need to know, oh, this is a, this is a symptom. Symptoms are signals of dysfunction. Let's catch 'em and go in. Not just dismiss them, brush 'em under the rug for a decade, and then be like, I'm, I'm in a black hole. Now what? You know? Really flipping the script to listen to our body and trust it. You're with your body 24 7, not a healthcare provider. You know, what's that? This isn't right. My hair falling out. I know it looks like I have a lot of hair, but I'm telling you my hair's falling out and not being told by dermatology. That your vein, like that's happened in our office, like not having to go get hair extensions because your hair's falling out. No one's believing you or that. Chronic pain in women is dismissed so many times as mental health anxiety. Go see the psychiatrist, you know, for this chronic pain situation. And it's like you're learning more about scoliosis and hearing from you. It's like, ah. Like, I've had a very well known female in my office be like, I was sitting in the, in the waiting room of the mental health place. Like why am I here? I literally have a heart rate of 130 right now. I have a physical symptom that's being dismissed as bad anxiety and panic attacks. I can tell you my hair's falling out. I have tachycardia and I got sent to mental health, like knock it off. That's a great place. I am so for mental health, but it's, and right, like what? It's that and mm-hmm. And, and, and it's. There's physical symptoms and mental health. Let's touch both of them please. Like, let's not just do one and dismiss the other. That's not being a real thing in this conversation. If I could like put a laser beam into, mm-hmm. Here's this conversation, it would be women in their twenties and thirties because, so what ends up happening? So we talk about like mm-hmm. You know, osteopenia, osteoporosis, all those things. So this is what happens. So we miss it and, and I'm gonna, okay, we're gonna back up. I'm gonna give a disclaimer. So. From a scoliosis perspective. What this does not mean is like, okay, you go, you do all these things and all of a sudden your congenital curve, right, is magically fixed, right? No, that doesn't happen. You just said it congenital, right? Like, or, or say even say you've got a 40 degree curve and. You do all of these things, where's the promise and the expectation, right? So we're not promising that you do all of these things and all of a sudden your scoliosis resolves spontaneously. Right. Right. Or that all of a sudden it 100% is, is gone better magically, you know? Right. Forever. We have to have reasonable expectations. Yes. But when we look at a person as a whole and their health, this is what I can tell you. When patients come into my office, say, I've got two separate patients. If I've got a patient that works, shift work. They don't exercise, they're drinking 40 to 60 ounces of caffeine, whether that's, um, red Bulls, monsters, coffee, bubblers, whatever, fill in the, fill in the blank, right? Yeah. Um, they're not eating well. They're stressed out. They've got kids at home. Like all of those pieces, right? Yeah. And then, so I've got a patient who. Some of this is not changeable, right? So say you work at a hospital and you're doing shift work, right? You can't change that, but how do you support your life? But then there's this other piece where you've got somebody who's sleeping well and they can exercise and their diet is healthy and they're doing these things. If they had the same situation, the patient who has better overall general health is going to do better with any treatment that we give them. Obviously, because their body can respond to it better, they can adapt to it better. All of those things. So just kind of a disclaimer that what we're talking about isn't just this magical, like, Nope, fix it button, cure that. Like, okay, you no longer have to deal with your scoliosis. Go do this and I'll make it all better. Right. But the thing that really is, is so sad for me that I just, it tugs at my heart when these patients come in is because. They're told like, don't worry about it. Go on, do your life. It won't affect pregnancies. It won't affect, and And that's true, right? Yeah. Like, okay, you can have scoliosis and you can have a family. You can have pregnancies, you can have normal childbirth. You can do all these things. You can still run, you're races, you can go work out, you can do CrossFit, you can do all of those things. But they kind of have given an idea of like, okay, you're done. Like you don't have to worry about it. And then. All of a sudden in their forties and fifties, they come in and now we have osteopenia, we have osteoporosis. That limits what I can do to help them because we can't, we can't put like a hard force into a scoliosis, like say a lumbar or scoliosis that is degenerative, that has some lassis. So like if a bone is shifting off a bone and we've got disc issues and they've got osteopenia, or maybe the beginning of osteoporosis. There are a lot of things that I can no longer do with that patient. And so now it also, so now they're limited surgically, they're also limited in the realm of what I can help them with and we can still help them. So I never wanna say it's not, um. There's still hope. Like yes, we have managed lots of patients that have increased quality of life, but it still does limit that. So if I'm, like, if we could have this conversation with people in their twenties and their thirties, and if they could just understand that they have more tools and if they can be proactive and get ahead of it, it opens up doors that they, they don't even know that they need yet. You're, you're like talking about what, what if. Teens knew that they could do that. What if, what if we started at the teens and like educate the teen girls on this stuff and so that as they progress through life and, and they, they know this stuff. Like how empowering is it to like, think teens and 20 year olds could know this so that when they get to that point in life, it's d it looks different than it did for us and our moms and grandmas like a whole different. Mindset. But you can actually change that process somewhat too, right? Like that's what you're saying too, is like to know that there's more out there than what they've been told. It's like, and to not fall for, I don't know, can I just say it like hard? It's hard. If it looks hard, too good to be true. It is too good to be true. I don't know. Like it, it, and just to validate that time too, right? Like. We get it. Like you're, you're wanting to fix this and do everything possible, but you don't have to travel for it. You don't gotta go. There's more than one person that can do what that person. Is doing. Mm-hmm. I like a better way to put it, like, you don't have to go all the way across the country. You can get that right in your backyard if you find the right team that knows what they're doing with that and the coordination of it, like you said, yeah, let me take this piece. Yes, I'll take this piece. Yes. And how do we work together? Yeah. Right. Absolutely. I often time, I, I have pa lots of patients where. Like they see their chiropractor, they come see me for their scoliosis care. And then we've got other providers that are, are on board. And the more we have of that, yep. The better these patients will do, the better outcomes we'll have. And, and sometimes it's not, um. I wanna say too, not every patient that comes in the door gets the thing. Right. Right. It's not like the, the new thing where everybody gets the same thing sounds very individualized like it should be. Right. 'cause sometimes it doesn't fit. Right. Right. And we adjust and pivot, like you said, that shift work person's gonna need a whole different plan than the non shift work person. Mm-hmm. But it's doable. Right? It's doable. You're not just out because you do shift work. There's a lot that can be done to work around that lifestyle for you. And we talk a lot about like what's the top priority, right? So what can we do right now that will get you the farthest, the fastest? And where do we prioritize our time, our effort, and our money? Yep. And where are the non-negotiables? Because if we've got a kid who's 10 years old, like say they're 10 or 11 and they're coming in and they've got a. 40 degree curve. Their priority is gonna be a whole lot different than say like, I've got a, an eight or 9-year-old that comes in and their curve is at 15 degrees. Like, we're gonna treat that different just like we would treat somebody in their thirties or forties. Different and Absolutely. And that's where we've gotta have the people. And so that's why I'm so thankful that you guys are here. Yeah. And a lot of people don't even know that. Don't that, like, don't, we've got these people. Yeah. Here, I always joke about our office, like if they, if people, some people have heard of us, that's like, wow, what is this? Unicorn. I'm like, there's a clinic like mine in every corner, in every major city. Fun fact, like what I do, we are just very up to date. We are constantly chasing the latest changes, especially in hormone health specifically. No matter are you went through fertility, are you a teen getting your period? Are you entering perimenopause, menopause, men's health, like we are up to date on that. What is, what is the research showing? What are some options to help optimize you? You don't have to go on an airplane nowadays. And, and there's telemedicine, right? Like that's the beauty of telemedicine. And our practice has telemedicine too, but many places offer telemedicine. You don't have to tra, you shouldn't have to travel much nowadays to get really high end care and unique other options. Like I feel like I'm not that unique, but I feel like I have to say that because what we do is so different in the area. Is unique, but really it's just a different view and a different angle and specializing in hormones. Is there anything after our conversations today that we didn't talk about that you would want people to know or you feel like would be pertinent to or topic today? Yeah, I feel like we could probably have like a 10 part series, you and I on stuff, but. Hormones are a real thing. I don't care what your age is. Um, we know hormones are forever changing. So whether you're a pediatric, a teen, a young female, young male, perimenopause is real. The the standard of care for menopause has changed. It is here. So if you are a patient, I don't care, male, female, teen, pediatric, whatever, you do not feel good. You're not getting answers. You don't feel heard. You want a different option. You wanna get a couple different opinions. You have the right to do that. You, you might have been told that this is the only way. There's more than one way, right? Medicine is an art too. We forget that it's not a one size fits all plan, and you are in control of your body. Nobody, no healthcare provider should be navigating that for you. You should feel good and confident and walk out of that appointment feeling heard, but really good with your plan. And if you do, that's amazing. That's what it should feel like. And if you don't, there's other options out there. There just is, um, in 2025 a time recording this. Hopefully people will be listening this 10 years from now still. But there's rapid changes happening. We are nerds in my office. You can find me at a conference probably every month and my staff as well. And we are just gonna be able to help walk you through those changes. And because patients are getting that stuff online. We talked about that earlier, right? So the point is don't become Dr. Google. Go out there, look what's going on. But you're on social media, you're on TikTok, Instagram, Facebook, podcast, YouTube. Great. There's a lot of great providers putting information out there, especially about hormones and advancements and stuff like that. Patients are catching up with that. Providers are not. So if there's a different road you wanna take as a patient, no matter what your diagnosis is, take it you, you're in control. Thank you so much for coming today. I can't tell you how much we appreciate having Oh, yeah. You guys here, you're welcome. In our community and to help, um, we are going to link some. Different links to my clinic and Dr. Tara Harding's Clinic so that you have access and you've got some resources. So, uh, look on our podcast, you can find, uh, her podcast as well. So we'll include all of that. And as always, if you have any questions, reach out to us. Thank you so much for being here today. Thank you for having me. Yes. Thanks for spending time with me today. If you could leave a review before you go, that would help us reach more people that need this message. To learn more about the services and resources that we have available, visit us at behindthebrace.com.. This show is produced by RAYMA Team Media. To learn more about how they can help you with your podcast, visit raymateam.com.

3. 

   23 Sept 2025

   Season 1: Episode 12 - The Art Of Bracing And What You Need To Be Aware Of

   In this episode, Dr. Mandy explains the differing reasons why bracing is used and the intricate pieces of bracing that make each case so unique. If you've ever received differing recommendations from a handful of providers that has left you confused and not sure what to do, then you need to listen to this episode! Listen in to find out helpful tips and be sure to check out the links below for more information! *****Resource Links You Need: Contact Dr. Mandy's office to learn how to work with her by calling (701) 223-8413 or email her at info@drmandychiro.com (mailto:info@drmandychiro.com). Free Online Screening Tool: https://app.scoliscreen.com/ (https://app.scoliscreen.com/) Find out more about ScoliBalance® at https://scolicare.com/patients-scolibalance (https://scolicare.com/patients-scolibalance). Find out more about ScoliBrace® at https://scolibrace.com (https://scolibrace.com/). *****Transcript***** Hi, I'm Dr. Mandy Dietz and you're listening to the Behind the Brace podcast. Each week I'll be sharing conversations and resources to help families and providers navigate the world of scoliosis. This is your place to find hope for a better solution so that you can live your best life. Welcome back. This week we're talking about the art of bracing and what you need to be aware of, so lots of conversations around bracing and what that's used for. So last episode, we talked about kind of the details of what that looks like, and just some general basic information. And today I wanna talk about more how it applies to you and how we use bracing. So traditionally speaking, when we're talking about bracing, most of the time we're talking about either juveniles or adolescents, kids that are growing, that are diagnosed with either scoliosis or hyper kyphosis that are wearing a brace because they're growing. And essentially what that means is when kids are growing, if they've got a scoliosis, if they're not in a corrected position as they grow, that curve can progress. When the spine grows and growth plates continue to grow, when there's pressure on certain sides of that growth plate, the the bone and the spine will actually start to grow in a deformity. So that's essentially what the goal is for bracing in kids that are growing. And that's why when you go see an orthopedic surgeon or any other primary care provider that works with scoliosis, if you have a child that's got a scoliosis or a hyper kyphosis and they're growing, they're going to put them in a brace. So that's pretty straightforward. That's general recommendations. Everybody that would see a case like that should be doing that if that's where you're at. And then based on where they're at, specifically with their age and where their growth plates are at, the severity of their curve, lots of different things. Family history, that's where they determine, you know, are you wearing a brace? How long are you wearing a brace? What kind of brace? So whether that's a brace at night or that's a full-time brace or what that might look like. So that's pretty general, and I would say most people know that that's something that's coming. If you have a child that's growing with a scoliosis. So here's where the intricate pieces come in because there's a lot of different recommendations across providers, and I've personally had conversations with families and even other providers about these scenarios and then different recommendations and why they might be different. So that's really what I wanna speak into because there can be some confusion, and I know when parents come in. You come in and you talk to us in our office, and then for whatever reason, whether it's insurance or a second opinion, or maybe there's something else going on, you go see an orthopedic surgeon, they give you a different recommendation. That orthopedic surgeon says, "Hey, why don't you see our physical therapist while you're here?" And then you go see the physical therapist. And the physical therapist gives a different recommendation from the orthopedic surgeon and from our office, right? And then you're left with three different recommendations. And they're kind of all similar, but they're also different. And then you leave all of these appointments and it's overwhelming. So I wanna help clear some of that up today because there is different scenarios, and different goals and purposes that play into some of these recommendations. And so I'm gonna speak about a scenario that happened in my office that looking back at that, I was like, gosh, you know, we really should have been more clear in some of this information because it would've been really helpful. So, say you have a child who maybe is a little bit older, say they're 13, 14 years old, they are more towards the end of their growth. So they measure that. If you're not familiar, they talk about like, Risser sign, right? So Risser 0, 1, 2, 3, 4, 5. So, Risser five done growing. Growth plates are closed. If you are like Risser one , 2 0 1 2, you know, you're still gonna be growing. You've got that fast growth phase coming up. You know, Risser three. So they base it off of those classifications. So if you're not familiar with that, of course you can always go Google it and you can look and see what it, what it shows as far as the bone and what that means and what that looks like. So we've had more than one case where somebody will come into our office and they've never been diagnosed with a scoliosis or anything. They come in, we find that they have a scoliosis. We take an x-ray, and it's in this range of say like 27 to 35 degrees. And patient might be between the ages of like 13, 14, 15 , maybe they've already had their menstrual cycle for a while, and we look at their growth plates and they're like a Risser four. So when we're looking at that and parents are coming in, some of the history of that might be, you know, our child's really active, they're having some trouble with sports, or maybe they're having trouble pitching in softball. They're having pain in their back. They're concerned about their posture. You know, most of the time it's girls like going into high school that, you know, in a swimming suit, they're like, gosh, you know, this one rib is sticking out, or my shoulder is down. When I put on my clothes, my clothes sit funny. And so they're coming in with these concerns, but then also the parents are maybe new to this too. And they're wondering, okay, well we have this curve, like we don't want our child to have surgery and you know, this is at 28 degrees or 32 degrees, you know, whatever it might be. And so what do we do with this? And so from our lens. So using a ScoliBrace®, when we're looking at that based off of our braces that we provide, that are made through 3D technology that are over corrective, that when we fit you with that brace, we actually get correction in that brace. When we're looking at that, we approach that scenario from knowing that if you've got a curve that's under 30 degrees, when you are done growing, it's less likely to progress as an adult. So essentially what that means is if you've got a 32, 35, 36 degree curve, even if you're done growing, those curves can progress as you age through your adult life. So especially if we've got a kid in that range, they're having pain, it's affecting their daily life, even if they're close to done growing. We can utilize that brace to give correction in the brace, and if the patient is compliant, we've been able to get correction of those curves where. We look at multiple things. Are we able to reduce pain? Are we able to help correct the posture to make their posture more balanced? So essentially their body functions better, more biomechanically, and also they have less postural issues, meaning that aesthetically then that child is happier with what their posture looks like. But then also a goal of, can we reduce the curve, keep it under 30, or if it's over 30, can we get it under 30? Even though they might be a little bit older than say what an orthopedic surgeon might brace. And so we've had these conversations and we've chatted about this and then, you know, for whatever reason it might be, they go see an an orthopedic surgeon. And the orthopedic surgeon is like, "well, they're Risser four. Um, they've had their menstrual cycle for a while and their curve is 27 degrees or 33 degrees, and so essentially they're kind of done growing, so they don't need a brace, you know, no worries. Go see our rehab person. They'll work with you and then we'll see you in six months." Or maybe, you know, sometimes they might say 12 months. Depends on where they're at. Then they go see the rehab person and they'll show them some exercises and they'll say, okay, here's your exercises. When you come back in three months, six months, or whatever it might be. Then we'll go through them again, and then the family leaves and comes back, and then we get a phone call, talking about saying like, well, the orthopedic surgeon said we didn't need a brace. The rehab person said that we just need to do these exercises and come back in. Six months, three months, whatever it might be that we don't need to do this regularly. And then it comes back to the conversation we had where we were talking about utilizing a brace and utilizing our specific rehab program that we have, which essentially, depending on the patients as far as like the, how often we see them, but we generally do like a 12 session program initially and hopefully see those, that patient every week for 12 weeks to build on that. It's very corrective focused and specific, and it's a scoliosis specific exercise rehabilitation program. So as you can imagine coming back from all of these recommendations, we now have three different providers, three different recommendations and three different pieces of information. And the reality is that they're all accurate. Which is frustrating. And so that might sound odd when I say they're all accurate to you, because when I think of something like, well, somebody has to be right, like who's giving the bogus recommendation, right? But it depends on the lens in which you're looking at it. So when we work with families and when we work with you, we look at what are our concerns? Where are we at? Right now, let's lay out the information and then let's make recommendations that, first, make sure that, you know, medically speaking, we're doing the right treatment protocols to make sure that you're safe and we're preventing any sort of, you know, negative thing from happening. Meaning we don't want your child to go to surgery. But then also what are the concerns that you came in with and how do we work with that, right? So, here are the different lenses. So that family that I spoke about, when we come in and we look at through that lens, yes, they're almost growing, done growing, but we still have an opportunity to make change. We're focusing on being proactive. Reducing the curve as much as possible so that they can have a better long-term prognosis as an adult functioning throughout their life. Especially if they're already having symptoms, if they're already noticing postural effects, if it's already making them self-conscious, if it's already affecting their mental and emotional wellbeing in that sense, right. As they get older, those things will only continue to progress, right? Because in general, say you had a perfect healthy spine. We all know as we age, things start to have wear and tear. It start to degenerate. It's not uncommon that adults in their fifties, sixties, seventies, have degeneration in their spine, in their joints because you've used them for 60 years. So if you've got a curve in your spine, it's more likely that you're going to start to see those changes in that breakdown. Faster as you age, especially if those curves are over 30 degrees. So we're looking at it from that lens of how can we best serve you using the tools that we have that we know are effective? And so if we shift over to say, the orthopedics point of view, they're looking at that as. Okay, this child is almost done growing. They've had their menstrual cycle. The curve is either it's right under 30 or over 30, right in that area. And so knowing that they're, say like a Risser four, it's less likely that you're going to have progression of that curve. So when they're looking at it from, is this kid going to end up having to have surgery? Unlikely is the answer. So from their perspective of what they're evaluating is, is this a child I'm gonna have to do surgery on if we don't intervene? If the answer's no, they typically don't do anything with that. And also depending on what braces they provide at their facility, oftentimes the braces that they might have available to them are more stabilization braces. So they may not actually get correction of the spine and the braces they have to offer. And so if that's the case, then they're right. It's not worth having a brace because it's not going to do anything to make it better. And if there's a low risk of it getting worse, they wouldn't use that brace. So that makes sense. So they're giving a solid recommendation, even though it might be different then the recommendation we've given. And then fast forward, so say now you're done with the orthopedic surgeon. You go see the rehab physical therapist that they have there, and maybe they've had some courses in say, Schroth or some scoliosis training or some other PSSE program that's different, right? So each program is different and the applications are different. And especially if you're coming from a distance, right? If you are driving 400 miles, one way to go to this specialty hospital. There is almost a 0% chance that you're coming back weekly to see these rehab specialists. So they have to fit their program differently because it's just not realistic that people coming from a long way away are going to be able to come in regularly or build a program around that. So that being said, that's a piece of it, right? But then they also aren't familiar in the rehab programs that we have available in our office. And that conversation comes up where they'll say, you know, I'm not familiar with that program, so I don't know, based on our program, you shouldn't have to come in as often, but we can't speak to each other's programs because we're not necessarily familiar with it, and we're not trained in that. So then you hear a different recommendation from yet another provider who's doing the rehab. And you can even potentially, I had this happen once where the orthopedic doctor had made a recommendation for rehab and then when that patient got to the physical therapist's office, the physical therapist was like, oh, actually no, I don't agree with that recommendation. After seeing you, this is what we need for rehab. And then that conversation comes in of like, well, the orthopedic doctor knows the general consensus of rehab, but based off of my evaluation, it really needs to look like this. And so it can get really confusing and really muddled. And so that's what I want to just open up the conversation about because it's not always, it's never actually black and white. Every single patient, every single scoliosis, every single presentation is different. I have never had one, like more than one patient that I have managed or gave recommendations to exactly the same. It just doesn't happen because you have different activities. Patients live different distance distances from you. There's different abilities for compliance based off of your life. Other medical diagnosis and, just like so many different factors, and underlying family history. And in addition to that, you know, one of the things that has recently come up, and this is knowledge really for anybody across the board, whether you're a parent, whether you're a provider, listening to this, there's even scenarios where I was just having a conversation about this with another provider, so. If you approach every scoliosis case the same, there is no doubt that at some point something really not great will happen because they are not the same. So I recently had the conversation of there was one patient in one office that was, I believe, I can't remember the exact age, but I think it was like 13 years old. And had a double curve. The curves were, you know, relatively midline, so like under 30 degrees. So based off of an orthopedics recommendation, maybe not bracing, classification yet. And so this provider had managed this case a certain way and they actually saw some changes in the curve and the patient had gone on and not had any progression and not had any additional problems. And so when we were having this conversation, it's like, okay, so if we have a patient who's 13, they haven't gained a grown in six months, so they haven't gained any height in six months. They've had their menstrual cycle for two years. They're a Risser four. They're almost done growing at that like 13 and a half. So they're like early in the stages, right? When you manage that scoliosis, they have a really low risk of it progressing. So it worked out well for them. But then on the flip side, there was another office that had a 13-year-old who hadn't had her menstrual cycle yet. She was a Risser two, so she hadn't had her really fast growth phase yet, so she's still growing. And her curves were just under 30 degrees. So kind of in that same realm, they looked very similar, but there was a completely different history there because she had been growing in the last six months. And so you stack all those things together and you've got a kid who hasn't had their menstrual cycle yet, which is so to backtrack. The onset of the menstrual cycle for the first like 18 to 24 months is when the most progression happens. If I didn't say that. So that's important to know. So if you haven't had your menstrual cycle yet, your growth plates are still at a Risser two, meaning you have a lot of growth left, you have been growing in the last six months. Those curves are just like in those twenties, right under 30 degrees. That patient was managed in a very similar way, except in a four to five month period of time. That patient had progression and now is in a place, you know where they need a brace. So you can have two kids seemingly the same, but the underlying factors are different and you'll have two totally different outcomes. And so you can't use this like box to kind of fit people in to what do you need to do with this? Because if you don't know the intricacy of all of the underlying factors. You really could guide somebody in a way that could be really detrimental to not just their health, but like leading to a surgery that could have been prevented. And so some of these conversations are the things that I wanted to talk about because we do a lot in our office with bracing that maybe don't fit within the box, but we are able to really help people in ways that's, you know, outside of the box of what you might be able to get in a hospital or a different facility or a different bracing facility and things of that nature. So in addition to that, there's some other cases along with that where we talk about, you know, adults with degenerative cases where they're old enough now that, you know, surgeons don't really wanna touch it, they don't wanna do a fusion. It's not completely unstable in their spine, but it's affecting them day to day and they just don't have the ability to do the things they wanna do. And so those are cases where we've done adult bracing for those cases, and we're not worried necessarily. About the cob angle. So when we talk about like, oh, you have a 45 degree curve. When we're looking at that, our goals are different. We're taking the patient in front of us and we're figuring out what can we do to help them with the things that are most important. So if that same patient went to go see a surgeon, they're not likely going to brace an adult. They're not likely going to use their braces to be able to help with some of the things that they're experiencing. And most often they'll say, well, if it's not bad enough, we're not gonna do a surgery. So then patients are just left with not a whole lot of options other than you know, some traditional physical therapy and then eventually pain management, where we can have that same patient come into our office and we can have the conversation about, okay, what's, what are our goals here? And we've really been able to utilize that brace in a way that we can help adults have more stability. We can use that brace to get more global balance, meaning that if we constantly feel like we're falling forward when we walk, we can help bring their body back and over their pelvis. But then we can also use that to help stabilize. So say they've got a double curve. They're leaning to their left or they're leaning to the right, we help stabilize and get them up upright and straight, and then we can utilize that brace to do some rehab and strengthening in that position. And we've seen some great results where people that weren't able to even like bend over and tie their shoes or get their shoes off or be able to unload the dishwasher or even vacuum, are now able to do those things, or to pick up their grandkids. I can't tell you how many times I've had that conversation about, you know, well, I can't pick up my grandkids. If I get down on the floor to play, I can barely get myself back up again. And so it may not be within the box of what the mainstream community might use, but we have been able to use the brace that we provide along with our rehab programs to really be able to help those people gain their quality of life back and their daily activities. The same goes with different neurological conditions. So it may not be that, say, you know, we've got a patient with either like cerebral palsy or Parkinson's or MS or different neurological conditions that we know are associated with a higher incidence of scoliosis or hyper kyphosis. Obviously we're not taking away the condition that's creating the scoliosis, right? So if we have cerebral palsy or if we have a different neurological condition that's creating a scoliosis, that condition's still going to be there, but we can provide a brace to help keep that patient more stable, more upright, keep their spine corrected while they're in their brace, and to help utilize that to gain strength and to create a rehab program that fits their specific situation that they can do, that can be really helpful. And so out of all of those things, when we look at how we utilize our brace, there is an art to working with families and patients and finding the spot that really helps them utilize the tools that we have to get the results that they want. And it can be really confusing when you're hearing other things, but that's where I really want people to start to recognize that there's a different lens in which we're looking at that. And so you have to take into consideration who you're seeing, where you're going, and what their lens might be and what they're looking at as far as what are they trying to prevent, and how are they giving you those recommendations. Because in that scenario I presented to you at the beginning, that family got three different recommendations. And again, they were all accurate, but we have to come back to what are we trying to accomplish? What's important to the patient? What are our goals? And then based on those, how do we move forward? Because if your goal was simply to avoid surgery, or if your goal was to simply not have progression, then those recommendations are absolutely right. Then you know what, you probably don't need a brace and you probably don't need to do rehab very often because you've pretty much already obtained those goals based off of where you're at. But if your goal is to reduce your pain and symptoms. Increase your activity to be able to have less injuries while you're playing sports, to correct your posture so that you're more comfortable with how your body looks and all of those things. And to help reduce the curve so that long-term as an adult, it's less likely to progress and cause you problems, then those recommendations might not necessarily be the ones you want to follow. And so it's really about opening up the conversation within your family and other providers as well to understand the information about scoliosis and hyper kyphosis, what that means, and then how do you make your decisions off of that? Because you can have recommendations that are completely different and also be accurate, but it may not fit what you want for you and your family and what your goals are. So this is a very in-depth conversation to have. But I wanted to just kind of scratch the surface of it to open up the conversation. And I know that there's going to be people that listen to this and they're gonna say, well, what about fill in the blank? And so if you're one of those people that you're like, gosh, well what about this? I really do urge you to send us a message because those questions are important and I think having clarity or even knowing what to ask is really important. And one of the things that we offer in our office is what's called the discovery call. So if you have a situation scenario that you're really looking for some guidance or just some information, if you reach out to us, we have a free 15 minutes discovery call where we chat with you. We get some information ahead of time and we can talk through the scenario to see, okay, is our office something you know, that's for you or do we feel like you need to be seen somewhere else? And then can we direct you to that place. And so it's really worth that conversation. We always have our website and on our socials you can send a message and we can connect with you that way. If you have any additional questions or if you want some more information, we can provide that. We will be back in the next couple of weeks with some new episodes, and until then, I hope you have a great week. Thanks for spending time with me today. If you could leave a review before you go, that would help us reach more people that need this message. To learn more about the services and resources that we have available, visit us at behindthebrace.com. This show is produced by RAYMA Team Media. To learn more about how they can help you with your podcast, visit raymateam.com.

Who has been a guest on Behind The Brace Podcast

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• Dr Mandy J Phillips
• Dr Meghan Teed
• Teresa Teuscher

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