A neuroscientist’s view: spare children the manipulations of chiropractic quackery

There is simply no evidence based on proper clinical trials that spinal manipulation can ameliorate children’s conditions. AAP

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/15/1/2).

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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