Ep 149: Truths and Myths: What can be done to prevent sports injuries? With Dr David Skaggs, pediatric spine surgeon

Episode 149 with pediatric spine surgeon, Dr David Skaggs.  In this conversation, Dr Skaggs explains what can be done to prevent and recover from sports injuries.  We discuss  sleep, stretching, lifting and even ice baths, and what he says may surprise you!    Please stay tuned for episode 150 with Dr Skaggs, where we discuss back pain in general--common injuries, red flags and recovery and prevention.   He is a wonderful doctor and human being, and I am so grateful to have had Dr Skaggs on Ask Dr Jessica.

Dr David Skaggs is the director of Pediatric Orthopedics at Cedars-Sinai Guerin Children's Hospital and the coo-director of the Cedars-Sinai Spine Center.  He is a leader in spine surgery and an expert in the treatment of spinal disorders and deformity in children.  He is accepting new patients, 310-423-6665.

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

For more content from Dr Jessica Hochman:
Instagram: @AskDrJessica
YouTube channel: Ask Dr Jessica
Website: www.askdrjessicamd.com

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Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.

The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

Transcript

Unknown: 0:00

Hi everybody. I'm Dr Jessica Hochman, pediatrician and mom of three. On this podcast, I like to talk about various pediatric health topics, sharing my knowledge, not only as a doctor, but also as a parent. Ultimately, my hope is that when it comes to your children's health, you feel more confident, worry less and enjoy your parenting experience as much as possible. Hi everybody. I am so excited for you to hear today's episode. My guest is the esteemed Dr David Skaggs. He is the director of pediatric orthopedics at Cedars Sinai Children's Hospital, and he's the co director of Cedars Sinai Spine Center. And today we talk about ways to best prevent sports injuries, and we discussed so much, including sleep, meditation, stretching, weight lifting and even ice baths. I find Dr Skaggs to be the rare combination of smart and humble, and he's a really interesting and easy person to talk to. Make sure and stay tuned for next week's episode where I continue my conversation with Dr Skaggs. Next week, we talk about back pain. And also, if you're enjoying this podcast, I would be so grateful if you would share it and leave a five star review. Dr Skaggs, I have to tell you, I am so excited to have you here on my podcast. Thank you so much for taking the time to be here. Well, thank you for inviting me. I'm delighted. I have to tell you, I first heard you give a lecture about 11 years ago, and I enjoyed the lecture so much that I kept the notes and I continue to quote you very frequently to my patients. So thank you so much. You have no idea the impact that you've made on my practice as a pediatrician. Oh, that warms my heart. So now I'm curious, what do you quote to your patients? There's a few things, actually, and I look forward to bringing up those points. But first, before we get started, I want to tell everybody a little bit about yourself. Tell everybody who are you? Who is Dr Skaggs, and what do you do for a living? Okay, my name is David Skaggs. I'm now the co director of spine at Cedars Sinai. I spent 25 years of my career at Children's Hospital, which is a wonderful place. Actually, you could see just over my shoulder there, that's my oldest daughter, who is a PGY three orthopedic resident at Stanford, and she hates to admit it, but she likes spine and peds also. You know, who am I? I guess I'd have to first say, hopefully, a good husband and father to my three children. I love going to work every day. I love caring for patients, and I love leading a team. I think that we're very lucky in academic medicine to be able to have such great effects in so many different areas. What I really enjoy about talking with you, because I've since met you in person, but you seem very well rounded to me. Not only are you proud of your career, but you also always talk about your wife and children, which I think is so wonderful, and your exercise habits, which I think are really impressive. Yes, I probably exercise six times a week. I love going to the gym in the morning for many reasons. Honestly, one of them is social, you know. And I think that we've all learned from covid how important being social is. I have this fantastic gym, Easton gym in Beverly Boulevard. I drive two miles towards Cedars Sinai, I stop at the gym and I drive like an extra five blocks and I'm at Cedars, so I'm able to work out almost every morning. Run into some friends. As I get a little bit older, I do get a little bit weaker, and my body hurts a little bit more, but I think that the real effects of exercise are not on your body, but on your mind and your happiness. And I think when you come to work after being at the gym, you more positive, and you're going to kind of spread sunshine to those that you come in contact with. So true. And your wife's an avid exerciser as well. Correct? Don't know if I showed you that picture, she used to make fun of me and the children for lifting weight. She'd be like, you lift up a weight, you put it down. Why would you do that? Then one day, her parents, you know, hired a trainer, and they couldn't use a trainer for a couple of weeks. Next thing you know, she became a professional card carrying bodybuilder. You know, at age 52 I was so proud of her. I still am. Yeah, you have to admit, I live in a little bit of fear that at one point, my wife may take up pediatric spine surgery, and then there won't be anything left that I'm better than her at and, you know, and if you're bringing up, you know, exercise, I used to be embarrassed to talk about this, you know, I wanted people to know that I grew beer and I played rugby. I didn't really want people to know that I meditated when I was younger, because I thought it was kind of odd. But that is more important to me than exercise. I don't think I've missed a day in 20 years. So if you want to talk about, you know, preparing for the day, being a good person, that's probably more important than going to the gym. Amazing. I actually have heard that from quite a few successful people that that's a very important part of their life. Yes, I love that you do that. I presented it to a group of 1000 spine surgeons. It felt a little bit like I was coming out of the closet. And what was interesting is the people that have. Approached me afterwards tended to be people that ran the biggest departments or the biggest companies. So it was clearly the most busy and successful people in the audience were the ones that wanted to take up something new. And I'm still in touch with a few of these people you know, to kind of go back and forth and say, How's it going? It's amazing. Do you do? TM similar. I do something called passage meditation. You know, tiam is one word. Passage meditation is, I have a few passages memorized from the Bhagavad Gita, the apana shots. Or, you know, prayer. Saint Francis is a pretty easily accessible one. So you kind of just do one word at a time. And, you know, some of the magic happens in the space between the words, I think it's so commendable that between your busy schedule, you still make time to meditate every day. Maybe I just need it more than others. So what I was excited to talk to you about was I feel like there are a lot of misconceptions about children and how they get injured. And I know that you as a spine surgeon, you actually see the injuries that happen from exercise. And so I wanted to first hear from you, what are the most common things that you see as a spine surgeon, so as a pediatric spine specialist, the most common injuries I see are things like spondylolysis. And, you know, doctors have to make a big word so we sound smart. All that means is you had a stress fracture in your spine, and it's generally down in the lower spine around l5 I want to be clear, though, when they look at a back pain in children, you know, spondylolysis is probably a cause in less than one in 100 children, you know, by the time they get to me, I'm seeing, you know, kids who have stress fractures of their spine, but the average kid who has back pain, it's just going to get better all by itself. You know, people shouldn't overreact to back pain. One of the things I tell them is, welcome to adulthood. It's only going to become more frequent. This is true. It's hard to meet an adult who has never experienced back pain in their life. This is true. So and my question is, so, I know we call them spondys for short, but when you see a spondy, what are the common reasons why kids have spondies? Yeah. So that's a great question, because spondys are actually present in 6% of the population, most people don't even know they have it. And it has to be somewhat genetic, because 37% of Eskimos have it, and most people have it, they don't even know it. And it's not a problem. The only time it's a problem is when it causes pain. So we tend to see it in athletes, particularly athletes that bend backwards a lot like gymnasts. You see all this crazy stuff of bending backwards so many times and many times, it literally leads to a broken spine. We also see it in all kinds of athletes, like pitchers, baseball pitchers in Division One, baseball pitchers, 17% of them had at least the beginnings of a spondy on a bone scan, because they do such violent, repetitive twisting motion. So in general, we think, you know, repetitive, violent motion about the spine could be a big contributing factor to spondys. That's so interesting. In medical school, we really focused on gymnasts getting spondys, but I never realized that it can happen incidentally as well. You know, what's fascinating now is I'm seeing it more even in volleyball players and other athletes. And I think part of what contributes is more and more children are being encouraged to just do one sport and maybe overdoing it. You know, all of a sudden they're supposed to do one sport all year round, many hours a day, and the rate of overuse injuries, of course, is going up. So this is what I'm excited to talk to you about, because when I've heard you lecture in the past, I love how you've you're a surgeon, but you've emphasized ways to prevent injury from happening in the first place, and and so in particular, you did a study showing the benefits of sleep and injury prevention. Yes, so it's interesting. This is the number one downloaded study of all time in the Journal of pediatric orthopedics. And we went to a local high school heart, by the way, that that has to feel good. Oh, that's awesome, like so the only reason I started doing research is because my grades weren't good enough to get into ortho. I completely came from a place of weakness. I realized it was kind of fun. So anyways, this this high school called Harvard Westlake in Los Angeles, and they keep psycho good records on every injury that ever happens to an athlete. And I had this theory that we were maybe overtraining our athletes, and we asked questions and tried to figure out is injury related to maybe going to a separate coach once you get home or. Other team, or lifting weights, or how many hours. And at the very end, just as a goof, I threw in sleep because I'm a big fan of sleep. I take a nap every day, actually. And it turns out nothing mattered except for sleep. And in fact, those kids who slept less than eight hours a day had 70% more injuries like that is a massive effect in medicine, you know. And like, if there was something for sale, we'd be seeing this for sale with billboards all over the world. But because no one really makes money on sleep, I don't think it's been quite that popularized. Wow. So just to summarize, kids that slept fewer than eight hours a day were 70% more likely to have injuries. Now, what kind of injuries are we talking about? Like sprained ankles? Yes, the most common injury in a high school athlete is a sprained ankle, and the injury was defined as any pay any athlete that was sent to the trainer, you know. So if you were sent to the trainer for an injury that was included, yes, of course, things like sprained ankles would be number one. And one would ask, like, you know, if you're tired, why do you sprain your ankle? Well, there's a lot of literature. And, you know, airline pilots, truck drivers, military if you're short on sleep, you become a little bit slower in your reaction time, and your judgment goes down. So it kind of makes sense that you're more likely to find yourself getting hurt. That's fascinating. And how did you how did you pick this as an area of interest to study? So again, this might come from a position of weakness, but if I don't take a nap, I get kind of cranky sometimes or sad. So even when I was a surgical resident, you know, back in the day, you'd walk uphill two times in the snow, and you'd literally work 100 hour weeks. So I would do everything I could to just get five minutes of shut eye. And I got pretty well trained to just like, fall into rim really quickly, and I think it makes all of us happier, and how you wanted to prove it. And I guess you know when you say something and your children make fun of you, you want to prove you're right. So that's why I did the study. For me. When I hear you describe this, describe this study, it really exemplifies how important rest and recovery time is for athletes. Absolutely, it's no question. One of my friends, guy named Pau Gasol, played for the Lakers when they were winning championships, and he used to say that the rest is equally important to the training. You know, as he watched at the highest level of athletics, what limited people weren't was not a not training enough. He was training too much and getting hurt. So I guess I could say this. You know, if you watch the NBA games like during the regular season, it looks like the kind of dog in it. He's like, Yeah, of course, they're dogging it. They just don't want to get hurt. All that matters is the championship. So I think that rest is a very understudied, underreported, undervalued training tool. However, just after this study came out, I remember the professional soccer team at galaxy. I was chatting with their coach at the time when they were winning championships. He goes, this is absolutely true. I noticed if the guys go out the night before, they don't play as well the next day. And some of the teams even started putting things like Fitbits and over rings on the players, you know, to try to track their sleep. Now there was an unintended consequence. It turns out, if the players woke up and they saw from the over ring that they had a bad sleep, it could become a self fulfilling prophecy, and they thought they were going to have a bad game. So apparently they took the rings away from them. So interesting. I mean, sleep is something that inherently makes sense, that it's really good for us, but I love that you were able to show with medical research, validate how important it is. Yeah, especially for our children. What I worry about in our kids now is just more and more put onto their plates, and one of the things that suffers is sleep. I think it's some of the most intense schools. It's almost a badge of honor not to sleep, you know, I would know it was somewhat in college or med school. You'd like to, like, I just pulled an all nighter. Like, man, I'd do horrible if I pulled an all nighter. You know, I'm just not that tough. I completely agree with you all. Throughout my medical training, it definitely felt like a badge of honor to stay up at all hours, to not need much sleep. But for my mother in law, who thankfully listens to this podcast every week, she is, I know, smiling and nodding in agreement with everything that you're saying right now, great. And then one of the interesting things is, you know, I train surgeons, which is just one of the most fun things in the world. And when you're a surgeon, you're trained for 1000s of hours to be technically superb and make the right diagnosis. You know, think clearly, you're not really taught how to lead a team, and all of a sudden you go into the operating room as a new surgeon, and you're leading a team. It could literally be life or death. And one of the interesting concepts. In leadership is there's good studies showing if the leader sleeps well, they do better as a leader. And if the leader has a bad night's sleep, the team notices it. The teamwork isn't quite so good the next day. So at some level, you know, of course, it must be true for surgical decision making and skills and mood and all the other things. But there's really your sleep affects others. Once you become the leader, it makes so much sense. On a personal note, when I get a good night's sleep, I completely feel the benefits. I can tell with my relationships, how I talk to others, how I treat others, how I feel. In general, everything's better, yep. So I like your studies. This is great, great stuff. So on the same theme of injury prevention as a spine surgeon, are there any other things that people can do to prevent back injury, like, for example, I hear a lot about weightlifting, that if you weightlift and you focus on the core, that will prevent injury to your back, is this true? I don't know. I don't know if that study has been done, but you raise a really important point. One of the number one ways I see people injure themselves is dead lifting or squatting too much. No question that dead lifting and squatting, especially large amounts of weights inser people's spines all the time. And if you're having back pain, yeah, it's super important to do core strengthening. And you know, I put together a PowerPoint of exercises that I think are great. And you instead of squatting, you know, 225 pounds on your back, you could do much less with one leg at a time, so then you're unloading your spine, but you could still build the muscles around your core equally effectively. That's a great tip. And the same thing with deadlifting. Do you feel like if you just emphasize one leg at a time, the mechanics of it? You know you have this weight in front of you, and as you lift up, the moment arm across your lower back is horrible. I've had a few kids who felt a pop, and all of a sudden they have a, you know, a disc herniation pushing against the nerve, and they need surgery. And it's kind of, you know, it's not healthy to have a bunch of teenagers, usually boys, trying to compete who can lift the most. You know, that's a sure way to support your local spine surgeon. So how do people know when is enough? Are there any guidelines so that people know when they've reached their max? Yeah, you know, I think for things like dead lifting and squats, I would go so far to say, just don't do it. It's not worth the risk. But if you're going to do it, I think it's really important to have professional instruction make sure you doing it correctly. I think there really is a much lower injury rate if you're doing it correctly. And you know, why not go for 10 reps to exhaustion instead of one rep max? There's no question you'll get injured less. You know, most of us are not trying to win the Olympic gold medal. We shouldn't pretend that we are. I love this point, because it's easy to get cut up in the gym culture where you're constantly trying to increase the amount of load that you're lifting. So it's a good reminder that we can all get injured. Yeah. And the other thing that we should say about lifting is there's more and more evidence now. It's particularly important later in life. You know, you all see the old person, like, can't get out of the chair. That's real. And as we get older, lifting and lift, lifting seems to be more and more important. And if we don't do it, our strength will just go down over time. And the longer you know, the older you get. Like, if you're sick in bed with covid for a week or two, it takes you a lot longer to recover than it does when you're younger, and it's particularly true with strength also. What you also raised was the idea of, you know, will core strengthening decrease your injury rate? I think that's pretty much universally agreed upon. You know, if you're in shape, if you're strong, the muscles are going to take a lot of the load, instead of your instead of your back and your bones. Now there's another area, though, that is a myth. As I say this, I know people aren't going to believe it, but stretching before an athletic event has not been shown to prevent injuries. Now, when I say something like that, it's like you're, you know, speaking against, you know, mommy rainbow and puppies. Like everyone thinks that stretching helps prevent injuries, and because of that, nobody believes the 20 or 30 studies that are out there proving it doesn't, and everyone keeps doing another study to prove stretching reduces injuries, and it's just not true. Now, a good warm up prevents injuries. You know, there's good things out there, like FIFA 11 that a lot of the professional soccer teams do. If you warm up everything, if your muscles are warmer and more flexible, that helps, but not necessarily just cold stretching interesting. So all that static stretching that I did in cross country for many years didn't do anything. Yeah, oh, let me do another myth bust. I love this one. So in college, I was an all American hurdler only because I was d3 I'm not really that good. Couldn't do d1 but I could barely touch my toes, and I got really upset, like every time I ever talked to a physical therapist or a coach, they'd all tell me, you know, I had a problem. I need to stretch more. I need to touch my toes. So we did another study, of course, and we correlated high school and middle middle school kids flexibility to athletic performance. And it turns out, if you have tight hamstrings, you jump higher. Isn't that wild? That is wild medical schools, we look back, you know, if your muscles are too long, yeah, they're not that strong. You know, there's an optimal muscle length that is strong, and it turns out it's having tight hamstrings. You know, loose hamstrings, or is, you know, everyone in yoga class and physical therapists tell you to loosen up your hamstrings, but I'd love to see the data on that being good. So in other words, if you can't touch your toes because you have tight hamstrings, it might even be favorable, certainly for jumping high. Yeah, you certainly shouldn't feel bad about it. You should be happy because of your superior genetics. I'm thinking of my husband. He played basketball for many years in high school, and he could never touch his toes, but maybe it served him well. Yes, overall when it comes to weightlifting, do you have a stance on whether or not it's beneficial for kids or not? Yeah, that's a good point. There is a belief out there that one should not lift weights while their growth plates are open. I don't think there's any evidence behind that. And if we think about high school physics, force equals mass times acceleration, F equals ma. And you know, simply a kid jumping probably produces more force on his growth plates than he does lifting weights or she does lifting weights. So my three children were in the weight room at age five. That's when we started saying, Hey, let's go to the gym together, and, you know, the kids all still lift and we come home for Thanksgiving. We love going to Eastern gym together. Amazing. I mean, it seems to me it comes down to form. If a kid is lifting weights that are too heavy for them, or they're not lifting them with good form, they're going to be a setup for having an injury. But if somebody's supervising them and they're using appropriate weights, I think it seems beneficial to me in so many ways. And you know, I love the fact that my two daughters literally grew up in a weight room, so by the time they went to college or now later in life, they are completely at home, walking into any gym and not intimidated. And I love how confident they are. It's amazing. I love what a proud dad you are? My kids are pretty good. Yeah, my my daughter, Jamie, who's 27 we're having pull up contests now we can both do 19. The problem is that she's doing more and I'm doing less. So I tell you another story of what a loser I am. So when my son was like 15 and 16, I started lifting heavier to keep up with him. And my wife is like, Dave, what do you do? This is going to end poorly. Next thing you knew, I had five hernias. I never heard of five hernias. On one side, I had a direct and indirect. The Other Side, I had direct, indirect and femoral I felt bad for the surgeon. After my surgery, he looked white, but you're okay now, I hope, yes, thank God, you're back at it. Oh yeah, yeah, I'm trying to hurt myself again. I'm kidding, Ashley. I really have calmed down and tried to lift less. You know, it's hard for all of us if we're successful in anything, whether it's work or athletics, to, you know, transition and realize that you're not 20 anymore. So I'm actually my birthday is today. I'm 44 and I think about that a lot because I go to the gym and I push myself, and I just have to, I just have to be okay with the fact that I'm never going to run as fast as I did at one time of my life. But I'm but I remind myself that I'm there. I show up, I try my hardest, and that hopefully counts for enough. Okay, I respect that you said that so much. You know, it's this odd thing where people don't want to say their age. You know, they lie about their age and different apps. You know, I'm looking at you. Not everyone, all of the listeners, can see you look like you're 30, but you don't hesitate to say we were ages. You're invited back, by the way, all going to age every year. Why are we hiding that? It's silly. I completely agree with you. It's the inevitable. I'd rather be aging than the alternative, that's for sure. Okay, the other, the other thing that I learned from you in the lecture that I heard you give, but the most useful recovery position after somebody does cardio, after they've worked, after they've been exercising in a cardiovascular fashion. What's the best, most helpful position of their arms to help ventilate the lungs? Yes, so you know, having run track in college, it was very, very common or doing wind sprints. For soccer right afterwards. You know what we all want to do, and we're really breathing hard, is like, lean over and for some reason the coach is like, No, put your arms above your head. Now, thinking back in med school, you know, remember when air goes into and out of your lungs? Two thirds of that is the diaphragm going up and down, and 1/3 of it is because the ribs go up and down in a bucket handle motion, and if you put your hands over your head, you're somewhat stopping the ribs from going up and down. So I thought of that in theory, you know, we did a study. We had people, you know, run and get really tired, and it turns out that you recover quicker if you bend over or put your hands on your knees or your hands on your hips, and you recover less quickly if you put your hands over your head. And that is just exactly the opposite to what every coach in the universe has ever said. But surprisingly, not too many people reacted to that paper. I guess no one makes any money off of that. No one sells anything off of that one. I really liked it because, to be honest, if I ever sprint, My instinct is to lean forward, rest my hands on my knees and catch my breath that way. But there have been so many times where I've been in a boot camp class or in track and they tell you to recover, just as you described, with your hands over your head. And so I think about you all the time, ever since I heard you give this information that I just stick to my I stick to my natural tendencies. Rest my hands on my knees, and I feel good about it. So thank you very much. What's interesting is the pulmonologist so like, Well, Dave, this is nothing new. We all know that. Like, how do you know that? They say when people are short of breath, such as COPD, they naturally want to lean forwards. So even, you know, the pulmonary world knows this, but it's funny, it's never translated to the, you know, world of sports. And you know, as you know, the world of sports has some myths, like, you know, this whole thing about ice. It's almost like a religion. You know, why would anyone think that making your muscle cold before going to train is a good thing. I just don't get that. Everyone's talking about ice these days. It's very in vogue, the ice baths, ice for recovery, cold, plunging. Yes, that'll be your next paper. Yeah, we'll have to look into that. And it's funny, you know, there's always, you know, someone who's getting famous because they're going to be the new researcher on ice baths, and five or 10 years later, when no one's doing it, you know, no one cares about them, and they never publish retractions. So, and what's interesting, though, is if people took the same resources, meaning time and money, and instead of, you know, going somewhere to sit in a cold bath, they just went to the gym and worked out they'd probably do better. But exercising requires a little bit more discipline than having somebody, you know, give you a massage or give you an ice bath or, you know, crack your back. I totally agree with you. I think that we know what benefits our bodies the most healthy eating, a good night's sleep, steady exercise. But those are also the hardest things to implement, yes, but one of the fun things to implement, though, is social connections. There's a number of studies showing one of the most important things is the number of genuine social connections, people who really care about each other, really ask deep questions. That's something that's good for you and fun. You know, though, I think we all, at some level, have a little bit of social anxiety, so it's hard to get to that activation energy to call off someone and go, Hey, you want to hike, you want to play golf, you want to go do something. I completely agree with you on that, especially more challenging. This is a tangent, but it's ever more challenging these days, when so much of the social connection, and I put connection and quotes that happens on social media and online, and it's just not the same, yes, where so many people show their phony best life, you all feel inadequate by comparison. I agree. I agree. Certainly, my almost 14 year old does not have social media, and she knows how i She hasn't asked about it yet, which I think is because she knows what my answer will be. I don't know what about doing a podcast. Is this social media? Well, I love all the myth busting that you've helped my audience understand. So many of my patients have kids that are athletes, and so I think just giving them some guidance on what is good for them to do, what things might be a waste of time, or what might be worth avoiding, I think is really helpful, Jessica. I always enjoy talking to you, and I love your insightful questions. Thank you. Thank you for listening, and I hope you enjoyed this week's episode of Ask Dr Jessica. Also, if you could take a moment and leave a five star review, wherever it is you listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask Dr Jessica, see you next Monday. You.