Chiropractic, one of the several popular so-called complementary and alternative medicines(1), should never be applied to children. It simply isn’t based on credible scientific evidence.
A practitioner filled with messianic fervor founded the chiropractic discipline in the latter part of the nineteenth century.
DD Palmer wrote “we must have a religious head, one who is the founder, as did Christ, Mohamed, Jo. Smith (founder of the Church of the Latter Days Saint movement), Mrs. Eddy (founder of the Christian Science church), Martin Luther (who did not found any religion) and others who have founded religions. I am the fountain head. I am the founder of chiropractic in its science, in its art, in its philosophy and in its religious phase.”(2)
Chiropractic maintains that most, if not all diseases, are due to some kind of misalignment of the vertebrae of the spine. The proposed underlying “subluxations” could be corrected by a special manipulation with a “high velocity, low amplitude thrusts” which reconstitute the flow of a mysterious “universal intelligence”. A significant proportion of orthodox chiropractors still hold this view.
The reality is that such chiropractic “subluxations” of the spine simply do not exist and that spinal manipulations have no bearing on general diseases unrelated to the spine.
The position statement of RMIT on the “vertebral subluxation complex (VSC)”, which is described as “ greater than a simplistic biomechanical concept”, leaves the issue confused.
The function of the nerves that leave the spinal cord to move muscles, and those that arrive to the spinal cord carrying sensory information for skin, joints and muscles, is well established.
Medical sciences are increasingly discovering the causes of disease processes that affect the sensory and motor nerves with resulting paralysis, pain, abnormal or absent sensations.
Why then do so many people still go to chiropractors? Not all pains associated with muscles, ligaments and bones have clear causes and medical doctors are often unable to help patients.
People with uncomfortable and often severely limiting back pains are drawn to any practitioner who claims to be able to ameliorate their discomfort, including chiropractors, osteopaths, and other alternative practitioners. Most people visit chiropractors for lower back pain (3).
Physiotherapy is the only practice based on physical methods that is well integrated and consistent with modern scientific medicine. The improvement of back pain symptoms in some patients undergoing manipulations, such as chiropractic and osteopathy (4) appears to be due to the “placebo effect”.
The “placebo effect” is being increasingly studied by medical researchers and shows how psychological expectations can influence the body by improving some conditions, although there is also the “nocebo effect” which can make things worse.(5)
It is therefore surprising that a webpage on Better Health Channel State of Victoria, with permission of the Victorian Minister for Health, and produced in consultation with, and approved by RMIT University’s School of Health Sciences, still claims that chiropractic is able to assist in a number of disorders including asthma, back injuries, headaches, lower back pain, migraines, period pain, problems with posture, sciatica, slipped disk and tinnitus.
There is simply no evidence based on proper clinical trials that spinal manipulation can ameliorate children conditions such as attention deficit hyperactivity disorder (ADHD), nocturnal enuresis, infant colic, asthma, or boost to the immune system. (6) Conversely there is extensive documentation of serious adverse effects caused by chiropractic spinal manipulations. (7, 8)
Despite of all this, some chiropractic organizations, for example the American Chiropractic Association, promote chiropractic care of infants and children under the theory that “poor posture and physical injury, including birth trauma, may be common primary causes of illness in children and can have a direct and significant impact not only on spinal mechanics, but on other bodily functions”.
In Australia many chiropractors still claim to be able to intervene successfully in complex diseases in children such as ADHD, autism and other behavioural problems, bed wetting, asthma, immune diseases and infant colic, among others.
A number of letters from experts of different disciplines accompanying a submission to the Minister of Health by Ms Loretta Marron, a long standing campaigner against pseudosciences in health, has called for the closure of a chiropractic clinic aimed at children run by the RMIT.
RMIT is rather vague about what they actually offer for children’s health, claiming that they do not aim to treat “conditions”.
Instead, they claim to look at the “biomechanical situation for an individual and make the appropriate gentle adjustments”.
This, they say, can improve the situations in other parts of the patient’s health but RMIT is not claiming a direct cause. They deny having a shopping list of conditions that they treat, apart from lower back pain, neck pain and headache.
Chiropractors who perform spinal manipulations on children, for conditions they should know cannot be cured by spinal manipulations, either believe the nonsensical principles of chiropractic – and this would amount to mere self-deception – or are deceiving parents of children. By their own admission “chiropractic is a profession, not a therapy” (9).
The existence in Australia of a specialized chiropractic clinic for children should raise serious concerns for the potential harmful effect of dubious practices (10, 11).
The confidence of patients on their health carers should be based on evidence-based practices, transparency and sound scientific principles, not superstition.
References
1) Shorofi S A and Arbon P (2010). Complementary and alternative medicine (CAM) among hospitalised patients: An Australian study. Complementary Therapies in Clinical Practice 16: 86–91
2) D.D. Palmer’s Religion of Chiropractic – D.D. Palmer letter, May 4, 1911
3) Lawrence DJ, Meeker WC (2007). Chiropractic and CAM utilization: a descriptive review. Chiropr Osteopat 15: 2. doi:10.1186/1746-1340-15-2 (http://chiroandosteo.com/content/15/½).
4) Ernst E, Canter PH (2006). “A systematic review of systematic reviews of spinal manipulation”. J R Soc Med 99 (4): 192–196. (http://www.jrsm.org/cgi/content/full/99/4/192)
5) Benedetti F (2009). Placebo effects; understanding the mechanisms in health and disease. Oxford University Press.
6) Glazener CMA, Evans JHC, Cheuk DKL (2009). Complementary and miscellaneous interventions for nocturnal enuresis in children (Review). The Cochrane Library, Issue 1. Wiley Publishers
7) E Ernst (2010). Deaths after chiropractic: a review of published cases. Int J Clinical Practice 64 (8): 1162–1165. (http://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2010.02352.x/abstract)
8) Singh S and Ernst E (2009). Trick or treatment? Alternative medicine on trial. Gorgi Books.
9) Vallone S A, Miller J, Larsdotter A and Barham-Floreani J (2010). Chiropractic approach to the management of children. Chiropractic & Osteopathy, 18:16, http://www.chiroandosteo.com/content/18/1/16
10) Martyr, P. (2002). Paradise of Quacks; an alternative history of medicine in Australia. Macleay Press.
11) Edwards, H. (1997). A skeptic guide to the new age. Published by Australian Skeptics Inc.
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Comments (16)
Chris Rook
(logged in via Facebook)
there is one crucial issue not covered here; the issue of the periodicity of these self-limiting problems (eg back-pain or knee pain etc).
After all, when are you most likely to go and see an alternative practitioner..........clearly when the pain is starting to become significant (eg back pain or knee osteoarthritis etc) and as sure as night follows day.........the pain will at some point subsequently subside again and the practitioner will claim credit. Most self-limiting medical problems have a cyclical nature.
I think this is the main driving force for the continued propagation of much of the alternative industry.
Marcello Costa
(Professor of Neurophysiology, Department of Physiology at Flinders University)
Hi Chris,
your point is well taken. Indeed many ailments come and go. Back pains are examples of such. Your advice seems to coincide with the father of the next comment by Meredith.
Chris Lloyd
(logged in via Facebook)
I agree with much of what you say. However, I personally know that chiropractic definitely can treat some forms of asthma. My brother received relief from chiropractic and no other therapy for many years. His asthma was perhaps special though because it was often brought on my trauma (to the back) during sport.
I also have found it effective for the treatment of acute back pain – when you know that you have put your back out and cannot self manipulate – though an osteopath could probably do just as well. For chronic back pain, I do not think chiropractic is effective at all, while being very expensive. Nor, however, is modern medicine much use, which to my mind is a huge embarrassment for modern medicine. Most middle aged males have serious back pain, and nothing can really be done.
Marcello Costa
(Professor of Neurophysiology, Department of Physiology at Flinders University)
Hi Chris, thanks for your, the first, comment! You are right modern medicine has concentrated on serious and life threatening diseases and should now be able to deal with the most annoying and often debilitating back pains. Next comment by the second Chris also give an explanation that may help. You experience with asthma demonstrates indeed how important are proper clinical trials based on large number of patients to avoid single experiences to determine if a treatment works or not.
Lauren McKnight
(logged in via Facebook)
I agree that all therapies should be subjected to evidence-based evaluation, however, I think this viewpoint is quite extreme. Firstly, it doesn't matter how a practice was founded, the truth is that most chiropractors and osteopaths these days have studied and subscribe to scientific principles. Although a few "interesting" philosophies remain (such as curing asthma with spinal manipulation), the increasing majority of practitioners have left these old theories behind.
In my experience, the practices…
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Marcello Costa
(Professor of Neurophysiology, Department of Physiology at Flinders University)
Dera Lauren, your comment is certainly based on sensible attitude as far as the need to do more research. I do not retreat from calling quackery what looks like quackery and feels like quackery. I support of course wholeheartedly multidisciplinary research and clinical practices. Modern medical sciences are just that. Relationships between immune system and metabolism or between any of the different aspects of living organisms, are being investigated by researchers based on solid scientific foundations…
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Eran Segev
(logged in via Facebook)
A major red flag for two of the comments is the "I agree, but" they start with. In my opinion, Prof Costa makes uncontroversial statements in highlighting the lack of good quality evidence for much of what chiropractors claim. Chris Lloyd provides a personbal anecdote to counter this, and Lauren McKinght thinks it's extreme to expect treatment modalities to provide good evidence to be accepted. Neither have been payinga ttention to the progress medicine has made since it started to be based on science…
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Lauren McKnight
(logged in via Facebook)
If I could just clarify a couple of things
Eran, you said "Lauren McKinght thinks it's extreme to expect treatment modalities to provide good evidence to be accepted. Neither have been payinga ttention to the progress medicine has made since it started to be based on science."
On the contrary, I intended to encourage research in these areas. I am a firm believer in medical research and am actually a medical researcher myself! Evidence based practice is certainly a crucial aspect of all therapies…
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Reasonable Hank
(logged in via Twitter)
It should be noted that the Better Health Channel also has information regarding the efficacy of homeopathy. Emails to the Better Health Channel highlighting concerns of advocating treatments for which there is no reputable evidence of efficacy have yielded nothing but Argument from popularity in response. Highly disappointing.
Marcello Costa
(Professor of Neurophysiology, Department of Physiology at Flinders University)
Thanks for the comment Hank, more than reasonable.
The wave of pseudoscience is ongoing. Only a solid ongoing barrier of many reasonable and determined people can counteract it. The conversation appears to offer a potentially important avenue for good science, good reasoning and good common sense.
Meredith Doig
(logged in via Twitter)
On a few occasions when I had some back pain, I asked my father, a physician, what treatment would be best. Friends had recommended massage, chiropractic, and osteotherapy. He said, "Yes, all of those will work in about 10 days -- and doing nothing at all will also work!"
Marcello Costa
(Professor of Neurophysiology, Department of Physiology at Flinders University)
Hi Meredith,
you have a very wise father and a proper physician. I assume his advice was effective!
You seem to confirming the suspicion that some practitioners of alternative practices, may take advantage willfully of the situation and get an undeserved reward!
Nene Peterson
(logged in via Facebook)
M. Costa-
You reference an excellent article:
Chiropractic approach to the management of children
Sharon A Vallone1,2,3*†, Joyce Miller4†, Annica Larsdotter5 and Jennifer Barham-Floreani6
http://chiromt.com/content/18/1/16#B44
(It is one article in an excellent THEMATIC SERIES in 'Chiropractic & Osteopathy' that provides an overview of the current best evidence in key aspects of evaluation and management of chiropractic care for children. Individual articles in the series address: chiropractic…
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Marcello Costa
(Professor of Neurophysiology, Department of Physiology at Flinders University)
Dear Nene, thank you for your comments. Not sure what is your argument, but the quote “chiropractic is a profession, not a therapy” you claim not to have found is on page 5 last paragraph. of the quoted paper.
Jean-Luc Gauthier
(Chiropractor)
I would just like to point out that there are some really interesting articles that have been printed out recently about the effectiveness of the spinal manipulation done by chiropractors on low back pain and the effect of cervical spinal manipulation on the sensorimotor integrative state of the brain. Here are the references:
Paul B. Bishop, DC, MD, PhDa,b,*, Jeffrey A. Quon, DC, PhD, FCCSCc,
Charles G. Fisher, MD, MHSc, FRCSCa,b, Marcel F.S. Dvorak, MD, FRCSCa, The Chiropractic Hospital-based…
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Marcello Costa
(Professor of Neurophysiology, Department of Physiology at Flinders University)
Dear Jean-Luke,
indeed there are interesting articles in all aspects of health research. I am aware of the one you quoted and plenty more.
The first of the two papers is very good and indeed involve genuine attempt to clarify the effectiveness of spinal manipulation as proposed by chiropractic. Interestingly the editors of the journal itself comment on the paper they accepted :“The outcome of the ‘‘outcomes movement’’ is, to some extent, still unclear, and even in this well-designed study limitations…
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