Chiropractors in Australia won’t be allowed to perform spine manipulation again on children under two years of age as a consequence of health problems doctors AND politicians.
But what is the spine treatment at the center of the controversy? Is it working? Is there evidence of harm?
We are a team of researchers specializing in evidence-based musculoskeletal health. I (Matt) am a registered chiropractor, Joshua is a registered physiotherapist and Giovanni is trained as a physiotherapist.
Here’s what the evidence says.
Remind me how this all happened?
Chiropractor from Melbourne published a video on social media in 2018 using a spring-loaded device (called the Activator) to govern the spine of a two-week-old baby suspended the wrong way up by its ankles.
The film caused widespread concern amongst the public, medical associations and politicians. This resulted in a ban on performing the procedure on babies. The Victorian Health Minister commissioned Safer Care Victoria to perform the study independent review spinal manipulation techniques in children.
Recently, the Chiropractic Board of Australia reinstated the authority of chiropractors to perform spinal manipulation on children under two years of age. But this week it’s turned backwardsfollowing heavy criticism from medical associations and politicians.
What is spinal manipulation?
Spinal manipulation is a treatment utilized by chiropractors and other health care professionals corresponding to doctors, osteopaths, and physical therapists.
This is a general term covering the popular “back cracking“techniques”.
It also includes more gentle types of treatment, corresponding to massage and joint mobilization. They involve putting pressure on the joints without generating a “popping” sound.
Does spinal manipulation in infants work?
Several international guidelines health care professionals recommend spinal manipulation to treat adults with conditions corresponding to back pain and headaches because there’s a wealth of evidence on the topic. For example, spinal manipulation for back pain supported by data from almost 10,000 adults.
For children it’s a unique story. Safer Care Victoria 2019 review spinal manipulation, only a few studies have been found examining whether this treatment is protected and effective in children.
The studies were generally small and of low quality. Some of those small, low-quality studies suggest that spinal manipulation has little or no profit for back pain, colic, and potential bedwetting – common reasons parents take their child to see a chiropractor. However, overall, the review found that the overall body of evidence could be very weak.
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However, for many other children’s conditions that a chiropractor treats – corresponding to headache, asthma, otitis media (a form of ear infection), cerebral palsy, hyperactivity and torticollis (“twisted neck”) – there doesn’t seem like any profit .
There have been even fewer studies examining the effectiveness of spinal manipulation in children under two years of age.
There was one high-quality study and two small, low-quality studies. They showed no appreciable profit from spinal manipulation colic, otitis media with effusion (referred to as glue ear) or sprained neck in infants.
Is spinal manipulation in children protected?
In terms of safety, most of the studies reviewed found that serious complications were extremely rare. The review reported the death of 1 infant or child (2001 report from Germany following spinal manipulation by a physiotherapist). The most typical complications were mild, corresponding to increased crying and soreness.
However, because the studies were very small, they can’t reliably tell us anything about the safety of spinal manipulation. Studies designed to properly determine whether a treatment is protected typically involve 1000’s of patients. And these studies have not been carried out yet.
Why do people visit chiropractors?
The Safer Care Victoria program was also carried out surveys involving over 20,000 people living in Australia who have taken their children under 12 to a chiropractor over the last ten years.
Nearly three-quarters said this involved the treatment of a baby two years of age or younger.
Nearly all people surveyed reported a positive experience after they took their child to a chiropractor and located that their child’s condition improved with chiropractic care. Only a small number of individuals (0.3%) reported negative experiences, and this was mainly related to the cost of treatment, lack of improvement in the child’s condition, excessive use of X-rays and perceived pressure to avoid medications.
Many respondents also consulted their GP or health/maternity/children’s nurse.
Now what about spinal manipulation in children?
At the request of state and federal ministers, the Chiropractic Council of Australia has confirmed that spinal manipulation in children under two years of age can be effective still banned pending further discussion of this issue with health ministers.
Many chiropractors consider that is unfair, especially given the strong consumer support for chiropractic care outlined in Safer Care Victoria reportand the rarity of reported serious harm to children.
Others consider that, in the absence of evidence of profit and uncertainty about whether spinal manipulation is protected in children and infants, the precautionary principle ought to be applied and spinal manipulation mustn’t be performed on children and infants.
Ultimately, high-quality research is urgently needed to raised understand whether spinal manipulation is helpful for the range of conditions that chiropractors provide and whether the profit outweighs the extremely low risk of great complications.
This will help parents make informed selections about their child’s health care.