MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Treating children is an important income stream for chiropractors and osteopaths. There is plenty of evidence to suspect that their spinal manipulations generate more harm than good; on this blog, we have discussed this problem more often than I care to remember (see for instance here, here, here, here and here). Yet, osteopaths and chiropractors carry on misleading parents to abuse their children with ineffective and dangerous spinal manipulations. A new and thorough assessment of the evidence seems to confirm this suspicion.

This systematic review evaluated the evidence for effectiveness and harms of specific SMT techniques for infants, children and adolescents. Controlled studies, describing primary SMT treatment in infants (<1 year) and children/adolescents (1-18 years), were included to determine effectiveness.

Of the 1,236 identified studies, 26 studies were eligible. Infants and children/adolescents were treated for various (non-)musculoskeletal indications, hypothesized to be related to spinal joint dysfunction. Studies examining the same population, indication and treatment comparison were scarce. The results showed that:

  • Due to very low quality evidence, it is uncertain whether gentle, low-velocity mobilizations reduce complaints in infants with colic or torticollis, and whether high-velocity, low-amplitude manipulations reduce complaints in children/adolescents with autism, asthma, nocturnal enuresis, headache or idiopathic scoliosis.
  • Five case reports described severe harms after HVLA manipulations in 4 infants and one child. Mild, transient harms were reported after gentle spinal mobilizations in infants and children, and could be interpreted as side effect of treatment.

The authors concluded that due to very low quality of the evidence, the effectiveness of gentle, low-velocity mobilizations in infants and HVLA manipulations in children and/or adolescents is uncertain. Assessments of intermediate outcomes are lacking in current pediatric SMT research. Therefore, the relationship between specific treatment and its effect on the hypothesized spinal dysfunction remains unclear. Gentle, low-velocity spinal mobilizations seem to be a safe treatment technique. Although scarcely reported, HVLA manipulations in infants and young children could lead to severe harms. Severe harms were likely to be associated with unexamined or missed underlying medical pathology. Nevertheless, there is a need for high quality research to increase certainty about effectiveness and safety of specific SMT techniques in infants, children and adolescents. We encourage conduction of controlled studies that focus on the effectiveness of specific SMT techniques on spinal dysfunction, instead of concluding about SMT as a general treatment approach. Large observational studies could be conducted to monitor the course of complaints/symptoms in children and to gain a greater understanding of potential harms.

The situation regarding spinal manipulation for children might be summarised as follows:

  1. Spinal manipulations are not demonstrably effective for paediatric conditions.
  2. They can cause serious direct and indirect harm.
  3. Chiropractors and osteopaths are not usually competent to treat children.
  4. They nevertheless treat children regularly.

In my view, this is unethical and can amount to child abuse.

13 Responses to Spinal manipulation in children amounts to abuse

  • My guess is that most chiropractors and osteopaths are sensible enough not to actually manipulate the child’s spine at all – but they create the illusion that they are doing so.

    Perhaps cracking their fingers, using a gag cracker obtained from a joke shop… who knows?
    Have any manipulators been critically observed during their procedures?
    And just as when assessing the Far-Eastern conjurors who ‘remove’ harmful tissue at psychic-surgey, the observer would have to be versed in techniques of misdirection.
    Just sayin’.

    We all know that most paediatric health care is directed at placating the parents.
    In the case of ‘spinal manipulation’ – by putting on a good show.
    That done, the child will be ‘better’ (by whatever criteria).

    We can be sure no ‘innate’ is re-directed, no subluxations adjusted, no arterial pathways freed of osseous encumbrance – because there is no plausible evidence such notions are anything other than figments of hyperactive imaginations, or deliberate quackery.

    • I am afraid may do manipulate the child and not the parents; there are plenty of horrific youtube videos on this

    • Most use “child-sized” drop-tables, often built to look like a pony or they use a myriad of adjusting “guns” telling themselves and the moronic parent that it “realigns the spine” without the “cracking”, “improving nerve transmission and healing potential”….Irrespective of the bloviating to the contrary, the subluxation (and osteopathic lesion) are alive and well and “it’s” elimination via “adjusting” available at virtually any chiroquackery facility…..excepting “DCs”. He apparently just randomly cracks his marks without rhyme or reason, or pretends he can practice as an exercise physiologist or biomechanist without-a-license….presumably so as not to look like a total quack?

    • @RR

      most chiropractors and osteopaths are sensible enough not to actually manipulate the child’s spine at all – but they create the illusion that they are doing so

      Judging by this and many more examples of (American) chiropractor’s marketing material showing variously absurd chiro-practice, freely available on Youtube and other internet video-repositories, you are probably correct.

  • Child abuse is typically defined as the intention to do harm.

    • child abuse. noun. physical, sexual, or emotional ill-treatment or neglect of a child, esp by those responsible for its welfareSee also nonaccidental injury.

  • The procedure demonstrated here is called “Extractio reditorum” in latin. (You can use Google translate if you don’t speak latin)

    • At what point did he commit child abuse?

    • Geir posts- “…. “Extractio reditorum” in latin. (You can use Google translate if you don’t speak latin)”

      UMMM……..

      — NO ONE ‘speaks latin’
      — Latin is a dead language…has been for quite a long time

      however-

      some people (you?) DO occasionally speak ‘pig latin’

      • Re your comment of 8.35am, you’re right: no one uses dead languages (e.g. Latin) these days. But isn’t your comment fallacious, i.e. isn’t it a non sequitur? As for your ad hominemcaveat emptor, I suppose.

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