Children and Chiropractic Care:
A Window of OpportunityThis section is compiled by Frank M. Painter, D.C.
Send all comments or additions to: Frankp@chiro.org
FROM: J Manipulative Physiol Ther. 2009 (Oct); 32(8): 603–605 ~ FULL TEXT
OPEN ACCESS Jan Hartvigsen, DC, PhD, Lise Hestbaek, DC, PhD
Nordic Institute of Chiropractic and Clinical Biomechanics,
Forskerparken 10, DK-5230,
Odense M, Denmark.Health and lifestyle early in life have profound impact on health and quality of life in later years. Common public health problems such as musculoskeletal disorders, cardiovascular disease, and depression tend to cluster in individuals, and this pattern is established early. At present, no health care profession has convincingly assumed the responsibility of spinal and musculoskeletal health for children. Considering the magnitude of the challenges ahead for both researchers and clinicians, this may be a good opportunity for doctors of chiropractic to take responsibility and engage in a determined effort to bring forward evidence-based strategies for prevention of spinal pain and other musculoskeletal problems. Chiropractors may play a significant role in finding and implementing evidence-based prevention and treatment strategies aimed at infants, children, and adolescents
From the FULL TEXT Article:
Background
The health and well-being of children is a natural concern for all parents and societies. This is not an expression of worry and pampering in affluent countries where birth rates are declining and time and money spent on children are increasing. From a health perspective, this development makes sense, and evidence is mounting that health and lifestyle early in life may have a profound impact on health and quality of life in later years. Leading causes of morbidity and mortality in the population such as cardiovascular disease [1, 2] and diabetes [3] originate early in life and appear to track into adulthood. [4] These conditions appear to be supportive to prevention by targeting specific lifestyle and behavioral factors such as level of daily physical activity4 and dietary modifications. [3] But what about spinal pain, which is the most common reason for seeking chiropractic care all over the world, [5–7] and other musculoskeletal disorders? Recent studies have shown that the pattern for these disorders appears to be similar: up to 50% of children and adolescents will experience back pain or other musculoskeletal problems in a 1–year period, and approximately one third of these will have recurrent episodes. [8–10] Furthermore, children and adolescents with back pain are more likely to have recurrent pain in adulthood, [11] and recurrent pain may develop into psychologic distress and illness behavior more disabling than the pain itself. [12]
Musculoskeletal Complaints and General Health
Spinal and other musculoskeletal complaints tend to occur in individuals who experience a range of other diseases as well, such as headaches, cardiovascular disease, [13] and depression. [14] Furthermore, the loss of function in one system has been shown to accelerate decline in other systems and thereby a deterioration of general health. [15] Such a cycle of frailty has been recognized in the elderly population, but this co-occurrence of diseases appears to begin early in life. [16] Musculoskeletal problems in children are associated with both physical and psychologic consequences, and they can become barriers for participation in physical activity and sports, resulting in negative consequences for the individual's health throughout life. [17] Insufficient levels of physical activity may lead to muscle weakness and bone fragility, [18, 19] decreased oxygen throughput, decreased arterial size, increased clottability and altered blood lipid levels, metabolic inefficiency, decreased glut transporters, obesity, type 2 diabetes, and immunologic decay. [15] Thus, prevention and treatment of musculoskeletal disorders in children and adolescents to increase physical and psychologic well-being and thereby reduce barriers for physical activity might not only prevent musculoskeletal problems in adulthood, but also be important in relation to prevention of a range of other public health problems.
Interventions in Children
The evidence for the effect of commonly used interventions aimed at improving the musculoskeletal health in infants, children, and adolescents is scarce. Ergonomic advice and exercise are popular interventions prescribed and recommended by both chiropractors and other health care professionals. Unfortunately, there is no evidence that ergonomic advice and interventions in the form of design and modification of school furniture or restrictions in the weight or design of children's backpacks are of much benefit in the prevention or treatment of musculoskeletal pain. [20–22] In chiropractic practice, spinal manipulative therapy is often used in the treatment of musculoskeletal disorders in pediatric patients. However, apart from one observational study, [23] the evidence base for this seems to rely on studies of adult populations, and it remains unknown whether the same treatment response can be expected in pediatric patients. There is, however, preliminary evidence that general exercise and activity of children can reduce the prevalence of back pain in children, [24] and considering the numerous other health benefits of exercise, such interventions appear promising.
According to a recent systematic review, chiropractors treat a wide variety of conditions in this age group, again primarily using various forms of spinal manipulation. [25] However, this practice is supported by only low levels of scientific evidence such as descriptive case studies, a few observational studies, and even fewer clinical trials, and in many cases, results of studies are contradictory. [25] One example is chiropractic treatment of infantile colic, which is popular in some parts of the world and where 2 randomized clinical trials are available. Unfortunately, the authors arrive at different conclusions regarding the effectiveness of the treatment ranging from “spinal manipulation is effective in relieving infantile colic” [26] to “chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic.” [27] The same lack of support is found for other common pediatric conditions where chiropractic treatment is used, such as otitis media, nocturnal enuresis, asthma, and learning disabilities. [25]
A Public Health Approach
So far, we have not found solid evidence for the effect of any treatment or lifestyle modifications that will alter the natural course of common musculoskeletal conditions. But maybe, more importantly, no health care profession has convincingly assumed the responsibility of spinal and musculoskeletal health in children and no health care profession has effectively linked prevention and treatment of musculoskeletal health to other public health problems. Considering the magnitude of the problems and the challenges ahead for both researchers and clinicians, this appears to be a very good opportunity for chiropractors to take responsibility and engage in a determined effort to bring forward evidence-based strategies for prevention of spinal pain and other musculoskeletal problems. At the same time, chiropractors have a unique opportunity to contribute to a broader public health–oriented agenda in relation to children and adolescents by joining the larger health care and research communities in finding credible and evidence-based answers and in implementing new and creative clinical strategies.
For example, doctors of chiropractic can:
play an active role in monitoring children's development, motor skills, and well-being through screenings and exams;
be involved in prevention and treatment of musculoskeletal disorders and lifestyle diseases through evidence-based clinical practice, promotion of physical activity, and injury prevention;
provide information and counseling about the health benefits of nutrition, such as breast-feeding and a balanced diet;
participate in public health campaigns and community programs targeting obesity, which is linked to a range of musculoskeletal disorders;
sponsor and participate in practice-based research programs where practice patterns are mapped, the effect of interventions is evaluated, and barriers to success are identified;
promote equal access to health services, including chiropractic, through professional bodies and community involvement.
Conclusion
The most commonly used treatment in chiropractic practice is the chiropractic adjustment and/or spinal manipulation. But chiropractors have much more to offer in addition to spinal manipulation and can play an active and important role in a broader public health–oriented approach to both individual patient care and to community interventions. [28, 29] We are working toward finding the answers and on defining the role of chiropractic in this arena. If the chiropractic profession becomes more engaged in activities as listed above, we can become a greater part of the solution for spinal and musculoskeletal health for infants, children, and adolescents.
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