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recalling this frightening experience during the summer vacation, xiaoyun's father is still in shock. he couldn't believe that a simple back bending movement would put his daughter at risk of paralysis!

xiaoyun is 8 years old, lively and likes to dance. xiaoyun's father runs a local late-night snack shop, which is very popular and always full of customers even at night.

during the summer vacation, xiaoyun played with her father in the snack bar every day. that night, as usual, she played alone while her father was busy, and practiced the waist-bending dance moves. however, as soon as she did the first waist-bending move, xiaoyun felt a sharp pain in her waist.the pain quickly spread to both lower limbs., immediatelysitting on the ground and unable to get up。

after a while, xiaoyun stood up despite the pain, but found that she could not walk. at first, her father thought that xiaoyun's legs were just numb and thought that she would be fine after standing for a while, but xiaoyun stood for a long time.the back pain still hasn't gotten better., still can't walk,feeling the urge to urinate but unable to urinate。

everyone was panicking, and her father rushed xiaoyun to the local hospital for emergency treatment. the doctor checked the lumbar spine ct scan and found no obvious abnormalities, but because she could not urinate on her own, she was catheterized locally and then sent to the pediatric department of zhejiang university second hospital overnight.

it happened that deputy chief physician zheng chaoguang was on night duty that day. "when i saw xiaoyun, she was in good spirits. physical examination revealed that the muscle strength of both lower limbs had significantly decreased, and the lower limb neurological pathology was positive, which highly suggested that the spinal cord was damaged."

sure enough, xiaoyun's spinal mri results later confirmed zheng chaoguang's judgment: mri scan of the thoracolumbar spine: abnormal signals in the spinal cord at the level of t7-t12 vertebrae, consideringspinal cord injury。

fortunately, the lower limb muscle strength was not completely lost.

discharged from hospital after 20 days

back to school in september

fortunately, xiaoyun did not completely lose the muscle strength of her lower limbs, which means that she still has a chance of recovery after active treatment.

after the diagnosis was confirmed, associate chief physician zheng chaoguang asked xiaoyun to rest in bed to prevent further injury, and gave her targeted treatment in a timely manner, using drugs to eliminate the edema of the damaged spinal cord, improve local microcirculation of the spinal cord, and promote the recovery of the injured spinal cord, while also carrying out active rehabilitation treatment.

during this period, xiaoyun also developed complications such as urinary tract infection, but they were quickly brought under control. after 20 days of active treatment, xiaoyun finally successfully removed the catheter, her muscle strength returned to normal, and she was able to stand up and walk freely again.

before being discharged from the hospital, xiaoyun had a follow-up mri, which showed that the spinal cord lesions in the t7-t12 vertebral canal had been basically absorbed.

xiaoyun was very lucky. she recovered so well because she was sent to the hospital immediately after the injury. early medical treatment, early immobilization, early drug treatment and rehabilitation treatment can greatly improve the prognosis.

when school started in september, xiaoyun returned to school.

acute hyperextension spinal cord injury in children

the culprit is "bending back"

70% of children face lifelong paralysis

zheng chaoguang said that the accidental injury that xiaoyun suffered is medically called "acute hyperextension spinal cord injury in children", which refers to acute thoracic and lumbar spinal cord injury without fracture or dislocation after children repeatedly or continuously hyperextend their spine. the age of onset of this disease is mainly concentrated in3-10 years old,in70% of children suffer complete injuries and face lifelong paralysis。

in addition to causing spinal nerve atrophy and paralysis, spinal cord injury can also cause many orthopedic complications, leading to serious consequences such as scoliosis, hip dysplasia, and hip subluxation.

in recent years, there has been an increasing trend of young children participating in dance training. bending the waist, a common dance movement, is the main cause of acute hyperextension spinal cord injury in children. statistics show that it accounts for as high as 64.1%. after an acute spinal cord injury occurs, lower limb pain, paresthesia, and weakness generally occur, and they will gradually worsen, with symptoms such as lower limb immobility, urinary retention, urinary incontinence, and bowel disorders.

"our long-term follow-up found that children with complete spinal cord injury rarely had improved neurological function, generally had a poor prognosis, and had many complications. among children with incomplete spinal cord injury, only a small number recovered to normal."

statistics from the department of pediatrics at the second hospital of zhejiang university found that in the past four years, the department has admitted six cases of acute spinal cord injury caused by bending down in dance movements, aged 5 to 9 years old. two of the children had complete spinal cord injury and are still unable to walk and are in a paralyzed state.

half an hour after i bent down

she lost feeling in her legs

this summer, 8-year-old girl jia jia also experienced a similar terrifying moment.

at the beginning of july, when summer vacation just started, her mother enrolled jiajia in a dance training class, hoping that dancing could help her improve her body shape and enrich her summer vacation life. but she didn't expect that less than a month into the dance class, one day at the end of july, jiajia was doing a waist bend in the dance class, and suddenly felt a sharp pain in her waist, and then she slipped to the ground.

at first, jia jia was able to stand up despite the pain, but after about half an hour, the pain in her waist became worse, and she lost sensation in both lower limbs and could not walk. her mother was so scared that she quickly called 120 ambulance and went to the local hospital for emergency treatment.

after the local hospital took a ct scan, it indicated a possible spinal cord injury and recommended transferring the child to a higher-level hospital as soon as possible. so the parents immediately transferred the child to the children's hospital affiliated to zhejiang university school of medicine.

when jiajia arrived at the emergency department of zhejiang university children's hospital, it had been seven hours since she was injured. shen zhipeng, deputy director of the neurosurgery department, immediately arranged for jiajia to undergo an mri and other examinations, and found that jiajia had obvious spinal cord injury and congenital tethered cord syndrome.

fortunately, jiajia's left lower limb muscle strength is level 2, and the right lower limb muscle strength is level 3, and she has not completely lost her muscle strength. on july 29, shen zhipeng performed a minimally invasive surgery on jiajia to solve the problem of spinal cord tethering. he then carried out targeted treatments such as eliminating edema of the injured spinal cord to promote the recovery of the injured spinal cord, and cooperated with rehabilitation treatment.

half a month later, jia jia's muscle strength had basically returned to normal and she was able to walk again. she was discharged from the hospital and returned home on august 14.

zhejiang university children's hospital admitted 7 cases in two years

"lower back paralysis" caused by dancing

two of them were high paraplegic

chief physician shen zhipeng said that in the past two years, the department of neurosurgery of zhejiang university children's hospital has received 7 children with spinal cord problems caused by learning dance. most of them were around 8 or 9 years old. five of them have recovered after treatment, but the other two children, unfortunately, died due to their serious illness.high paraplegia。

the patient who impressed chief physician shen the most was a 9-year-old girl from a city in zhejiang. she came to see the doctor in november 2022. when the accident happened, she was taking a dance class. after doing the waist-bending movement, she developed waist pain, loss of sensation in both lower limbs, inability to walk, and inability to urinate. after being sent to a local hospital, she was diagnosed with spinal cord injury. after receiving treatment such as deedema, she did not get better, so she was transferred to zhejiang university children's hospital.

but when she was sent here, four days had passed. the girl's lower limb muscle strength was zero and her spinal cord was in shock. this also meant that the child had lost the conduction function of the spinal cord and had lost consciousness from the chest down. this was basically high-level paraplegia in the clinical sense.

a seemingly ordinary waist bending movement

why is it so lethal?

in recent years, there have been frequent reports of children becoming paralyzed due to bending their backs while dancing, which has caused concern among many parents. according to relevant data, since 2005, more than 1,000 children in my country have become paralyzed due to improper bending of the back while dancing.

in november 2023, the ministry of education issued a reminder: children under the age of 10 should be cautious when doing spinal and waist body training such as "bending down" to avoid injuries.

why is a seemingly ordinary waist-bending movement so lethal?

in this regard, shen zhipeng, deputy director of the department of neurosurgery at zhejiang university children's hospital, said that the human spinal cord is a 45-centimeter-long tube shaped like a white string, located in the spinal canal. it is an important nerve tissue in the human body, responsible for transmitting commands from the brain and monitoring sensory information. the essence of "lower lumbar paralysis" is spinal cord injury. once the spinal cord is injured, it may lead to serious consequences such as paralysis.

when bending down, if you don't do a good job of warming up and takingwrong and violent practice methods, it is very likely to cause dislocation of the child's spine without fracture, mechanical compression after dislocation, and subsequent spinal cord damage.

children with lower back palsy

about half have a congenital spinal cord problem called tethered cord

many people usually have no obvious symptoms

in addition, it is found in clinical practice that among children with "lower lumbar paralysis", nearly half of them have congenital spinal cord problems - tethered cord. the 8-year-old girl jia jia mentioned above has congenital tethered cord syndrome.

tethered cord refers to a clinical syndrome caused by congenital abnormal development of the spinal cord, which leads to a series of manifestations. it is often found in newborns and children. during the growth and development of a person, the spinal canal grows faster than the spinal cord, and the lower end of the spinal cord should gradually rise relative to the lower end of the spinal canal. if various factors lead to the tethering of the lower end of the spinal cord, the spinal cord will be stretched, causing a series of manifestations such as abnormal bowel and bladder function, lower limb pain, sensory disorders, and movement disorders.

generally speaking, patients with tethered cord syndrome will have hair hyperplasia, hemangiomas, small parasites, depressions, etc. in the waist and sacrum, which indicate risks. it is worth noting that many children do not have obvious symptoms before the onset of the disease, and there is nothing unusual in appearance, so it is usually not discovered that the child has this disease.

why do half or more of the children with lower lumbar paralysis suffer from tethered spinal cord?

chief physician shen zhipeng said that the human spinal cord is equivalent to a "rubber band" that can move in the spinal canal. when the spine is stretched within the normal range, it has little effect on the spinal cord. however, once the spine is stretched significantly, such as by bending down, the "rubber band" inside will become tighter and tighter. once it exceeds the tolerable level, it will completely break, causing spinal cord injury.

"for children with tethered cord, the lower end of the spinal cord (conus medullaris) is constrained by the end of the vertebral canal for various reasons, so the tension on the spinal cord is higher than that of other children. in layman's terms, this 'rubber band' is being pulled tighter and tighter. once the spinal cord is over-stretched, it will be more likely to break than normal people, causing spinal cord injury," said shen zhipeng.

why do some children recover well?

some children will end up becoming paraplegic?

shen zhipeng said, "the recovery of a child's spinal cord is often a matter of 'yes' and 'no'. in other words, as long as the injured nerve function can be preserved and saved as much as possible at the beginning, such as the child is sent to the hospital in time, and still has muscle strength or limbs that can respond when arriving at the hospital. in this case, the child will basically be able to recover well in the later stage, otherwise the prognosis is not ideal."

"a small number of children may have a good prognosis even if their muscle strength is zero but they still have feeling in their limbs. this is a very special aspect of children compared to adults."

shen zhipeng said that there was a child who was unable to move due to a bent back problem. when he was sent to the hospital, his muscle strength was 0, but fortunately he still had feeling in his lower body. after 3 weeks of treatment, his muscle strength had recovered to level 1, and finally achieved good results.

the first 8 hours after injury is the golden treatment period

it largely determines the fate of the child after the injury

so, after an accident, how can we preserve and save the injured nerve function as much as possible?

shen zhipeng said that first of all, we should deal with it properly and not make things worse. when a child is unable to move due to spinal cord injury while doing similar movements such as bending down or falling, parents and teachers should not move the child rashly. due to the special nature of the spinal cord, non-professionals may inadvertently cause the condition to worsen further, leading to tragedy, so it is critical to call 120 immediately to seek help from professionals.

secondly,whether the child can be sent to the hospital in time will determine the fate of the child after the injury to a certain extent.。

generally speaking, the spinal cord can be divided into three parts: one part is normal nerves, one part is necrotic nerves, and the other part is injured nerves. after the spinal cord is partially injured, what we need to do is to protect these normal nerves and save the injured part of the nerves. through treatment methods such as hormone drugs for anti-inflammatory or spinal cord decompression as soon as possible, the nerves can be saved as much as possible and the spinal cord function can be preserved.

on the contrary, if spinal cord injury is not treated promptly, the longer the time is delayed, the more the spinal cord may swell and the more serious the damage to the spinal cord will be.

“the early stage of injury is the golden time for treatment, especiallyfirst 8 hours, the treatment effect is relatively good. if there is no obvious improvement in muscle strength after surgery and drug treatment, it will be more difficult to recover in the later stage. "shen zhipeng said.

5-10 year old children practice bending back

the risk is higher

in response to the ministry of education's safety reminder, some parents may wonder: why is the age of 10 specifically emphasized? does the risk of "lower back paralysis" decrease for children over 10 years old? shouldn't the younger the child, the softer the body, and the less likely they are to be hurt?

shen zhipeng said that generally speaking, the younger the child, the more water content in the nerves, and the stronger the resistance. therefore, for children under 5 years old, the spinal cord will be more tolerant to the bending action, and the tolerance will be higher. children over 10 years old are relatively stiffer, and rarely do some difficult folding actions, so the possibility of spinal cord injury is relatively small.

“therefore, relatively speaking,children aged 5-10 years are at greater risk of developing lumbar paralysis, and are more likely to be injured during dance practice, resulting in fractures and dislocations. children of this age can bend their waists much further than children over 10 years old, but the tolerance of the spinal cord is not as strong as that of children aged two or three. at the same time, the back has not formed muscles to protect the spine, so it is easy to cause spinal cord injury if not careful. therefore, children aged 5-10 need to pay special attention to the risk of "lower waist paralysis." "shen zhipeng said.

how to determine if a child has a tethered cord?

in addition to symptom comparison

i also recommend an mri.

so, how do you tell if your child has a tethered cord?

shen zhipeng said that children with tethered cord syndrome have common symptoms such as frequent urination, urgency, urinary incontinence, enuresis, constipation, and fecal incontinence. some children experience lower limb pain, numbness, fatigue and other symptoms. infants often have small depressions behind their buttocks. therefore, children with similar symptoms should be alert to spinal cord injuries in the lower back. parents should pay attention and come to the hospital for treatment as soon as possible.

in addition to comparing symptoms, a more reliable method is to go to the hospital for an mri. an mri before dancing can screen out children with spinal cord problems in advance with a high probability, especially for children with clinical manifestations of urination, defecation and lower limb function, and timely surgical treatment can be performed to prevent the possibility of paralysis in the future.

warm up thoroughly before dancing practice

learn step by step and do what you can

for children with normal spinal cords, they should also be careful to avoid fractures and dislocations when practicing difficult dance moves such as bending down.

"each child has different muscle strength and flexibility, so parents should also consider whether their children are suitable for learning dance." shen zhipeng suggested that children should learn dance in formal dance institutions, and if they practice difficult movements such as bending back, they should have the guidance and protection of professional teachers. within the range that the body can bear, they should gradually transition from low difficulty to high difficulty to practice dance movements.

before practicing,warm up thoroughly, reduce the probability of injury to children. when bending down, you should do it within the range of your body's load, especially concentrate to avoid accidents caused by distraction.

be careful not to overstretch when sitting forward bend

two children suffered spinal cord injuries in accidents

in addition to bending down, there is also the possibility of spinal cord injury when a child falls on his buttocks and sits on the ground or performs movements such as sit-and-forward flexion.

"even common physical exercises, such as bending over and lower body movements with a large range of motion, can cause excessive stretching of the spinal cord and lead to spinal cord injury. during the summer vacation, we also treated two children who suffered spinal cord injuries due to excessive stretching when doing sit-and-reach forward flexion."

in dance training, which dances involve more back bending movements? what should we pay attention to when practicing back bending? how to avoid injuries during normal practice?

the reporter interviewed teacher wang xiaoyu from hangzhou qidian children's growth center.

classical dance, folk dance, modern dance

involves more lower back movements

teacher wang's institution has been offering chinese dance courses for more than ten years. she said that judging from the types of dance that are usually selected, four types of dance, such as street dance, latin dance, ballet, and classical dance, are relatively popular among parents and children. among them, classical dance, folk dance, and modern dance involve more back bending movements, and other types of dance also involve them to a greater or lesser extent.

many people may understand that bending down means rolling the whole body down like an arch bridge. however, such movements rarely appear in dance works, and the degree of bending down half of the waist is more common. just like the dance poem "only green" that everyone saw on the spring festival gala in 2022, the "green waist" in it left a deep impression on everyone. it is actually bending down 90 degrees half of the waist.

"bending back is a basic dance skill, and almost all dance styles involve bending back to varying degrees. it's just that for relatively young children, we will simplify the dance movement design and basic skills requirements so that children can master it more easily. it's mainly based on the children's interests."

in addition to age restrictions

you also need to have enough waist strength

teacher wang said that in general, in addition to age, the most important factor for children to practice the waist bending exercise is the child's waist strength. "the waist strength we are talking about refers to the core strength of the waist, including flexibility and control of the waist. if the waist strength does not meet the requirements, it will also delay the time to practice the waist bending exercise."

bending back requires a high level of waist strength. some children get injured when bending back because of insufficient waist core strength and control. therefore, before children practice bending back, they need to exercise their waist strength. this includes waist core strength, flexibility, control, etc. when they have sufficient waist strength, then practice bending back, then the possibility of injury will be relatively small.

dance teachers must adhere to professionalism and principles

put your child’s health and safety first

"however, we have also discovered some phenomena. for example, some parents are very anxious. their children have been learning dance for a while, but why haven't they learned to bend their waists yet?"

at this time, some teachers may waver and start teaching children to bend back before their age or waist strength meet the requirements in order to meet the expectations of parents. this may easily lead to the risk of damaging the spine because the child's body is not ready yet.

therefore, teachers in dance training institutions should communicate more positively with parents, and pass on professional information and scientific practice methods to parents. at the same time, they should also adhere to their own professional and professional principles, not be affected by some external factors, put the health and safety of children first, and use professional care to protect the growth and progress of children.

practice bending your waist step by step

it is important to warm up for 10-15 minutes beforehand.

secondly, the back bending exercise is composed of a series of basic training movements. when training, you should pay attention to gradual progress, such as practicing kneeling down first, then kneeling down and grabbing your feet, then standing up and bending down, standing up and bending down and grabbing your feet. this is a process of increasing difficulty, so don't rush for success.

before practicing the backbend, it is recommended to warm up first. dance is a sports course, and you need to warm up in advance. you can do some stretching exercises before bending your waist to allow your muscles and ligaments to adapt in advance, and then increase the difficulty and intensity. generally speaking, warm-up exercises can last for 10-15 minutes.

the teacher stressed that you should not practice the movements at home on your own.

don't practice on your own

first of all, you should choose a qualified formal dance institution and a professional dance teacher for dance training. if you are trained in a formal dance institution by a professional dance teacher, the chance of waist injury caused by bending down is relatively small.

secondly, some children do the backbend movement by themselves after returning home from dance class, which is more dangerous because some children may have just learned the backbend movement, but their control ability is not very good yet. without protection, they may get hurt accidentally.

especially in many families with two children, the elder sister practices bending down at home, and the younger sister watches her practice and imitates her sister to bend down for fun. if the parents do not take good care of the child, it will increase the possibility of injury.

as a professional dance teacher, we must communicate with parents in a timely manner. all dance moves can only be practiced at home with the permission of the dance teacher. the teacher emphasizes that you should not practice the moves at home without permission.

source: chengshi interactive·metropolitan express reporter yu qianqian correspondent fang xulu qingzhu yaoling