Pediatrics

Spinal Manipulation and Exercise for Low Back Painin Adolescents: Study Protocol for a Randomized Controlled Trial

By Frank M. Painter|June 1, 2014|Chiropractic Care, Low Back Pain, Pediatrics|

Spinal Manipulation and Exercise for Low Back Pain in Adolescents: Study Protocol for a Randomized Controlled Trial

SOURCE: Chiropractic & Manual Therapies 2014 (May 23); 22: 21 ~ FULL TEXT

Craig Schulz, Brent Leininger, Roni Evans, Darcy Vavrek, Dave Peterson, Mitchell Haas

and Gert Bronfort

Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences
University, 2501 W 84th St, Bloomington, MN 55431, USA

Background Low back pain is among the most common and costly chronic health care conditions. Recent research has highlighted the common occurrence of non-specific low back pain in adolescents, with prevalence estimates similar to adults. While multiple clinical trials have examined the effectiveness of commonly used therapies for the management of low back pain in adults, few trials have addressed the condition in adolescents. The purpose of this paper is to describe the methodology of a randomized clinical trial examining the effectiveness of exercise with and without spinal manipulative therapy for chronic or recurrent low back pain in adolescents.

Methods This study is a randomized controlled trial comparing twelve weeks of exercise therapy combined with spinal manipulation to exercise therapy alone. Beginning in March 2010, a total of 184 participants, ages 12 to 18, with chronic or recurrent low back pain are enrolled across two sites. The primary outcome is self-reported low back pain intensity. Other outcomes include disability, quality of life, improvement, satisfaction, activity level, low back strength, endurance, and motion. Qualitative interviews are conducted to evaluate participants’ perceptions of treatment.

Discussion This is the first randomized clinical trial assessing the effectiveness of combining spinal manipulative therapy with exercise for adolescents with low back pain. The results of this study will provide important evidence on the role of these conservative treatments for the management of low back pain in adolescents.

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Chiropractic and Children: Is More Research Enough?

By Frank M. Painter|May 29, 2014|Chiropractic Care, Pediatrics|

Chiropractic and Children: Is More Research Enough?

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SOURCE: Chiropractic & Osteopathy 2010 (Jun 2); 18: 11 ~ FULL TEXT

Charlotte Leboeuf-Yde, and Lise Hestbæk

Nordic Institute of Chiropractic and Clinical Biomechanics,
Forskerparken 10, DK-5230 Odense M, Denmark. l.hestbaek@nikkb.dk

Many health science research and review articles end with the words: “More research is needed”. However, when it comes to research, it is not as much a question of quantity as of quality. There are a number of important prerequisites before research should be initiated. The three pillars, relevance, quality and ethics should be respected but for a project to be meaningful, it must also be based on plausible rationale.

In evidence-based (informed) practice, one takes into account not only research-based evidence but also clinical expertise and the patients’ perspectives. In this paper, we briefly discuss how this should be handled in clinical practice is briefly discussed, using the concept of “traffic lights” (red, yellow, green). We explain how the combination of evidence and plausibility can be used to reach a decision as to whether a treatment or diagnostic procedure is suitable, possible, or unsuitable.

In this thematic series of Chiropractic & Osteopathy a number of reviews are presented, in which the research status of pediatric chiropractic is scrutinized and found wanting. Two important aspects were studied in these reviews: the effect of treatment and safety issues. Two types of problems were identified: the lack of research in general and the lack of research using the appropriate study designs and methodology in particular. Therefore, we discuss the meager research noted in the areas of chiropractic care in children and the clinical consequences this should have. The prerequisites for “more research” are scrutinized and an example given of suitable research programs.

Finally, the important issue of implementation of research findings is covered, emphasizing the responsibility of all stakeholders involved at both the undergraduate and the postgraduate level, within professional associations, and on an individual level.

Introduction

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Possible Adverse Events in Children Treated By Manual Therapy: A Review

By Frank M. Painter|May 28, 2014|Adverse Events, Chiropractic Care, Pediatrics, Uncategorized|

Possible Adverse Events in Children Treated By Manual Therapy: A Review

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SOURCE: Chiropractic & Osteopathy 2010 (Jun 2); ; 18: 12 ~ FULL TEXT

B Kim Humphreys

Professor Chiropractic Medicine, University of Zürich and
University Orthopedic Hospital Balgrist,
Forchstrasse 340, 8008 Zürich, Switzerland.
kim.humphreys@balgrist.ch

Background Pediatric manual therapy is controversial within the medical community particularly with respect to adverse events. Pediatric manual therapy (Ped MT) is commonly used by a number of professions such as chiropractors, osteopaths and naturopaths for a variety of treatments in children. Ped MT interventions range from advice, light touch, massage, through to mobilisation and high velocity spinal manipulation. However, current evidence related to adverse events associated with Ped MT is not well understood.

Objective To update the clinical research literature from the 2007 report by Vohra, Johnston, Cramer and Humphreys on possible adverse events in children treated by spinal manipulation.

Methods A review of the clinical research literature from June 2004 until January 2010 as reported in MEDLINE, PubMed and PubMed Central for adverse events specifically related to the treatment of pediatric cases by manual therapy.

Results Only three new clinical studies, one systematic review with meta-analysis and one evidence report were identified. Two clinical studies reported on chiropractic care and one on osteopathic spinal manipulation in children. The systematic review investigated all studies of adverse events and manual therapy and was not specific for pediatric patients. The evidence review focused on effectiveness of spinal manipulation in a variety of musculoskeletal conditions. No serious or catastrophic adverse events were reported in the clinical studies or systematic review. However for adults, it has been estimated that between 0.003% and 0.13% of manual therapy treatments may result in a serious adverse event. Although mild to moderate adverse events are common in adults, an accurate estimate from high quality pediatric studies is currently not available.

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Chiropractic Approach to the Management of Children

By Frank M. Painter|May 18, 2014|Chiropractic Care, Education, Pediatrics|

Chiropractic Approach to the Management of Children

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SOURCE: Chiropractic & Osteopathy 2010 (Jun 2); 18: 16 ~ FULL TEXT

Sharon A Vallone, Joyce Miller, Annica Larsdotter, and Jennifer Barham-Floreani

Private Practice,
Connecticut, USA.
svallonedc@aol.com

Background Chiropractic (Greek: done by hand) is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on joint subluxation (World Health Organization 2005) or mechanical lesion and restoring function. The chiropractor’s role in wellness care, prevention and treatment of injury or illness is based on education in anatomy and physiology, nutrition, exercise and healthy lifestyle counseling as well as referral to other health practitioners. Depending on education, geographic location, scope of practice, as well as consumer preference, chiropractors may assume the role of primary care for families who are pursuing a more natural and holistic approach to health care for their families.

Objective To present a perspective on current management of the paediatric patient by members of the chiropractic profession and to make recommendations as to how the profession can safely and effectively manage the paediatric patient.

Discussion The chiropractic profession holds the responsibility of ethical and safe practice and requires the cultivation and mastery of both an academic foundation and clinical expertise that distinguishes chiropractic from other disciplines.

Research into the effectiveness of chiropractic care for paediatric patients has lagged behind that of adult care, but this is being addressed through educational programs where research is now being incorporated into academic tracks to attain advanced chiropractic degrees.

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Medical Management of Pediatric and Non-Musculoskeletal Conditions by Spinal Manipulation

By Frank M. Painter|January 23, 2014|Chiropractic Care, Non-Musculoskeletal Conditions, Pediatrics, Visceral Disease|

Medical Management of Pediatric and Non-Musculoskeletal Conditions by Spinal Manipulation

The Chiro.Org Blog

Chiropractic Journal of Australia 2013 (Dec); 43 (4): 131–136 ~ FULL TEXT

Peter L. Rome, D.C.

Melbourne, Australia

Thanks to Dr. Rolf Peters, editor of the Chiropractic Journal of Australia for permission to republish this Full Text article, exclusively at Chiro.Org!

Considering the unpleasant fallout from the Simon Singh Case, this article sheds a unique, new perspective on manipulative care for non-musculoskeletal conditions.

The Abstract: There is a well established precedent by medical doctors, particularly in Europe, of managing infant, paediatric and other patients for so-called organic conditions by spinal manipulation. There are also claims that chiropractic should not be involved with this form of management for so-called visceral disorders because it does not quite meet the current orthodox theories. This seems contradictory if not hypocritical when there is noted evidence in the medical literature itself of not only the rationale supporting these concepts, but evidence of medical doctors carrying out the same procedures for the same purpose on the same conditions.

Index terms: (MeSH): chiropractic; manipulation, chiropractic; manipulation, orthopedic; manipulation, musculoskeletal; manipulation, spinal; pediatrics; evidence based medicine. (other): medical manipulative therapy.

From the Full-Text Article:

Introduction

Some have questioned the hypotheses justifying chiropractic involvement in the management of paediatric patients, as well as those with so-called visceral conditions. [1-4] This topic was raised recently in a television program by Demasi. [5]

It is acknowledged that chiropractic constructs have been outside the traditional or orthodox models of understanding. However, there is a major contradiction regarding manipulative management of visceral and paediatric care due to the adoption of those very concepts by other areas of medicine – namely manipulative medicine. [6-9]

In particular, European medical doctors have published refereed papers on these very topics involving spinal manipulation in medical journals and medical textbooks for some decades. [10] (see Table 1) In an apparent contradictory development, it is primarily English language medical authors and other sources that seem to have attracted critics who direct their reservations at the principles espoused by chiropractors, but not to their European medical colleagues who are proponents of spinal manipulation. [11] It is also curious that osteopathic manipulative therapy does not appear to attract the same degree of debate and reservations despite the similarities.

There are at least three medical textbooks which include the topics of paediatric manipulative care and the manipulative management of visceral disorders. [6-8] One such medical text is totally devoted to paediatric manual therapy. [6]

INFANTS

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Children and Scoliosis

By Frank M. Painter|July 6, 2013|Pediatrics, Scoliosis|

Children and Scoliosis

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SOURCE: Dynamic Chiropractic

By Kim Christensen, DC, DACRB, CCSP, CSCS

Scoliosis is defined as “any lateral deviation of the spine from the mid-sagittal plane.” [1]

While there are many causes for scoliosis, children and adolescents with scoliosis who present to chiropractors usually fall into three categories.

Successful treatment is dependent upon differentiating the underlying cause of the spinal curvature. In most children, the scoliotic spine is not symptomatic; the spinal curvature is first noticed either by a parent who becomes concerned about a child’s posture, or during a screening examination, usually at school. The importance of a good evaluation and early treatment is to prevent progression and worsening of the curvature. Children with all three major causes of scoliosis should have a careful evaluation of the lower extremities as part of their spinal examination to determine associated or contributing components to the spinal deviation.

Structural vs. Nonstructural Scoliosis A structural scoliosis is defined as a spinal curvature that does not correct during recumbent, lateral flexion radiographs. The two most common causes of a structural scoliosis are congenital and idiopathic. A nonstructural scoliosis can be reduced when lying down, and will correct with recumbent lateral flexion. This type of spinal curvature is sometimes called a “functional curve,” and is often secondary to a leg length discrepancy.
Congenital Scoliosis Of the three major etiologies of scoliosis, this is the least common. Congenital scoliosis develops secondary to a bony anomaly of the sacrum, vertebrae or ribs. These are often defects of formation or segmentation, resulting in wedged, blocked, or hemi-vertebrae. In some cases, the abnormality will require corrective surgery. In many children, a heel lift or shoe buildup can provide sufficient structural support, and help to maintain a balanced spine.When a congenital spinal anomaly is discovered, it’s important to remember that there are usually multiple affected areas. For instance, it is more common to have multiple bony abnormalities than just a single level. Nonosseous and extraspinal deformities are also often present. These may include the cartilaginous and connective tissues, and even genitourinary or cardiovascular abnormalities. Clubfoot, a congenitally dislocated hip, or an anatomically short leg often will contribute to the spinal imbalance.
Idiopathic Scoliosis Idiopathic scoliosis can be progressive, worsening significantly during periods of rapid growth. In the more severe cases, bracing, or possibly surgery, may be necessary to prevent substantial deformity. [2] After skeletal maturity, most curvatures progress only slowly, if at all. Recent scientific research has focused on hormonal and neurological causes for idiopathic scoliosis, with some promising early results, but no definitive conclusions.

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