Dr. Lisa Goodman, DC
"The best time to plant a tree was 20 years ago, the second best time to plant a tree is now." This Chinese proverb is a great metaphor for understanding the infant spine exam. Addressing healthcare in infancy and early childhood is absolutely the best way to prevent disease in adolescence and adulthood. This is no different when talking about musculoskeletal health. Even if you simply think about the adult who suffered an injury in middle school or high school that never got adequately treated or dealt with, the argument would be that they should have had better musculoskeletal care in middle school or high school. Well, what would you think if I told you that they should've had better musculoskeletal care in infancy?
I have a YouTube channel that demonstrates infant chiropractic exams and adjustments. These videos are intended to show prospective parents, what is involved with examining a new baby and providing any adjustments needed. For some reason that escapes me, a lot of my videos are quite controversial. A lot of comments from viewers on the videos involves questions such as "why would a baby need their spine cracked?" and "how does a baby throw their back out?" The answer to why an infant would need their spine adjusted is so obvious: being born is one of the most physically challenging events any of us will ever go through in our entire lives.
Birth - our first athletic event
In chiropractic, there are no shortage of imagery and visualization involving trees, leaves, plants and growth as they relate to the spine. But one of my favorite is the following: "As the twig is bent, so grows the tree". If you've ever had a baby, watched a baby being born, or even if you've even ever spent a few minutes imagining the process of a baby emerging into this world, it should be fairly obvious to you that their body, including their head and spine, have to be pushed, compressed, rotated, bent and stretched to make their way out. No matter if the birth is medicated or unmedicated, vaginal or cesarean, breach or vertex, newborn infants undergo significant physical stress when they are born.
Flexible babies
Yes, babies are extremely flexible, and yes their bones are not even developed at birth (in fact our bones are not fully developed until our 20s). However the musculoskeletal structure of ligaments, muscles and tendons that is connecting the cartilaginous spine together is. In fact, while mom is pregnant, her body produces a hormone called 'relaxin' that is in turn translated to the baby's body. Relaxin is designed to help baby bend and flex on their journey and help mom's body create more room in her pelvis for an easy birth. Several days and weeks after birth, relaxin leaves the body of both mom and baby and ligaments start to tighten up into their normal resting state.
Early muscle memory
But..what if during the baby's journey - something got pulled, pushed, compressed, rotated, bent or stretched in a less-than-favorable position, angle, movement pattern or alignment? "As the twig is bent, so grows the tree." As flexible as babies are, and as undeveloped as their bones are, their body is already starting to create a pattern of muscle memory that will contribute to their adolescent and adult posture. One question I ask a lot of my adolescents with scoliosis is if they have a baby picture of themselves. Often times I'll see a baby picture that shows a head tilt to one side. When I asked, the parent may remember that their child often had a preference for one side while in a swing, carseat or even when nursing. Theoretically, if a baby with a head-tilt, becomes a toddler with a head-tilt their body may make a compensation further down the spine to level their eyes to the horizon, resulting in a developmental, idiopathic scoliosis. Obviously this is in a severe case of spinal joint fixation resulting in a postural adaptation.
Spinal joint fixations
When chiropractors perform an exam either on an infant or an adult, what we are looking for are spinal joint fixations. Are there areas of joints where bones are not moving smoothly or in other words, they are not sliding and gliding the way they are meant to? Anytime we have a spinal joint fixation, our body behaves less than optimally. In adults this could mean that we have pain, muscle spasms, or the inability to move fully through range of motion. In infants, this can mean their nervous system is not functioning optimally, with symptoms including colic, reflux, poor sleep, poor breast-feeding, constipation. Infants can also express musculoskeletal asymmetries, including a head tilt preference (ie. torticollis) or facial asymmetry, such as one eye being larger than another.
A word about shoulders and hips
Even if you think your baby's spine came through birth unscathed (and some do!) pediatric chiropractors also thoroughly examine baby's extremities - shoulders, elbows, wrists, hips, knees and ankles. I can count on two hands the number of clavicle fractures, brachial plexus injuries, hip dysplasias and club feet I have discovered after a pediatrician has done their exam. We work as a team! We are experts in the musculoskeletal exam, for people of all ages. All of these injuries are better discovered shortly after birth, rather than later in childhood or in one's teen or adulthood.
Infant adjustments
By now, hopefully you understand the need for an infant spine exam. And of course, if a joint fixation is found it will need an adjustment/manipulation. All that this means is that the chiropractor will gently and with finger tip pressure, slide the joint into the correct movement pattern or alignment. Most of the time babies sleep through their treatment. There is no popping, cracking, crunching or even sudden movements. Most parents leave the appointment saying "that's all you needed to do? I barely even noticed anything". Which is not to say nothing happened. Infant adjustments have a profound effect on them, they just don't need to be manhandled like the rest of us!
Your infant's spine is resilient and adaptable. This is true. However they may not simply 'grow out of' certain early joint fixations. With the correct attention, your baby may avoid many of the postural adaptations you have made throughout your life. "The best time to plant a tree was 20 years ago, the second best time to plant a tree is now." While we recommend infant exams at 4 weeks of age, it is never too late to have your first exam!
Lisa Goodman, DC, CCSP, CACCP founded Washington Park Chiropractic in 2006 in Denver, Colorado. Dr. Goodman is a Certified Chiropractic Sports Physician (CCSP) and Certified Prenatal and Pediatric Chiropractor (CACCP). She is TPI-L1 certified through the Titleist Performance Institute. She is also a CrossFit Level 1 and CrossFit Kids Certified Trainer. Dr. Goodman incorporates sports chiropractic techniques with prenatal and pediatric patients. She is a regular speaker at national events including Parker Seminars. She is part of the USGA Performance and Recovery Team. She is a member of the ACA Pediatrics Council and the ACA Sports Council. Areas of special interest include golf biomechanics, youth athletes, ankle and wrist injuries, instrument assisted soft tissue techniques. Stay connected with Dr. Goodman on Instagram @washparkchiro or @drlisagoodman
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