CF 165: Chiropractors Working On Kids

Today we’re going to talk about  chiropractors working on kids. Pediatric chiropractic. What’s the most current information and thinking. We’ll dive in a bit.  But first, here’s that sweet sweet bumper music

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

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You have found yourself smack dab in the middle of Episode #165  Now if you missed last week’s episode, we talked about the use of breathing for pain, we talked about the need for rehab, and we talked about forward head posture and its impact on shoulder function and/or pain.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Well, the Chiefs lost the Super Bowl and Tom Brady and the Tampa Bay defense won it last night as of the time of me typing this episode out. It was all interesting.  One of my buddies said that I need to find out Brady’s regimen for staying active at that level so that I could sell it at my practice. I looked into it.

Yeah….that’s not happening because only a person making $25 million a year would go to that extent. Lol.

Nobody is buying anything close to what he does in the real world.  But kudos to him. There’s no denying what he’s accomplished and how special of a QB he is. I want to hate the guy but dangit…..he’s just so damn nice. How can you? As we watch the COVID numbers steadily declining, as a result, I see my appointment numbers beginning to steadily rise. It’s exactly what I saw back in August and September when the number fell from the July spike. Then October came around with the second spike and said, “Whoa wait a minute…..not so damn fast.”

But this time, I feel good about the positive numbers coming back to stay. Maybe we don’t reach pre-COVID numbers in the next month or two but I can see this Summer patients starting to lose some of their fears and starting to venture back out into the world.  That’s all good for us, my friends. It’s alright alright alright.  I don’t have a lot of personal stuff to share this week so let’s don’t talk just to fill up space, let’s get right to it. 

CHIROUP 

Item #1 This first one is called “Pediatric Osteopathic Manipulative Medicine: A Scoping Review” by DeMarsh, et. al. (1) and published in Pediatrics in February of 2021 and holy roasted marshmallows that’s sticky hot. 

Why They Did It

A common reproach precluding the use of osteopathic manipulative medicine (OMM) in pediatrics is a lack of evidence regarding its safety, feasibility, and effectiveness. They say, “We conducted a systematic, scoping review of pediatric osteopathic medicine to identify gaps in the literature and make recommendations for future research.”

How They Did It

  • 10 databases were searched using 6 key words and medical subject heading terms for any primary articles reporting osteopathic manipulation use in children published from database inception until initiation of the study.
  • Articles were selected if they reported primary data on osteopathic manipulation conducted in the United States on patient(s) 0 to 18 years old.
  • Baseline study characteristics were collected from each article and the Grading of Recommendations, Assessment, Development, and Evaluations system was used to critically appraise each study.
  • 315 unique articles with 30 studies fulfilling inclusion and exclusion criteria

What They Found

  • Of these, 13 reported the data required to demonstrate statistically significant results, and no significant adverse events were reported
  • The majority of studies were graded as providing weak clinical evidence because of significant methodologic flaws and biases.

Wrap It Up

The authors concluded, “There is little strong, scientific, evidence-based literature demonstrating the therapeutic benefit of osteopathic manipulative medicine for pediatric care. No strong clinical recommendations can be made, but it can be medically tolerated given its low risk profile. High-quality, scientifically rigorous osteopathic manipulative medicine research is required to evaluate safety, feasibility, and efficacy in pediatrics.

Here is what I think about this; we need more research and not just because this papers says we need it. All research paper say that because the researchers like to keep themselves in a job. And who the hell can blame them? The DOs are in the complex. They’re in. They’re not outside looking in like us. We’re like the cold kids on the cold street shivering and looking in the windows at the family all toasty and warm eating an elaborate dinner. 

We always get attacked for using SMT on kids. It’s normal. Especially when there’s no real indication for using it. But, when the osteopaths and the medical field are saying there’s no research. There’s not enough to go on for osteopathic manipulation…..that goes for us too. I know of some doing research on the pediatric end of things but, the point is, if chiropractors want to normalize and validate SMT in pediatric patients, we need to be hitting the research hard on it. 

Item #2

This one is called “Maternal Report of Outcomes of Chiropractic Care for Infants” by Miller et. al. (2) and published in the Journal of Manipulative and Physiological Therapeutics in March of 2019 not hot but still a bit steamy. 

Why They Did It

The authors say they wanted “to investigate the report by mothers of their infants’ condition before and after a trial of care provided by registered chiropractic clinicians in addition to ratings of satisfaction, cost of care, and reports of any adverse events or side effects. A second purpose was to report the demographic profile of infants who presented for care to 16 chiropractic clinics in the United Kingdom.”

How They Did It

  • Observational study
  • Collected reports by mothers of their infants’ demographic profiles and outcomes across several domains of infant behavior and their own mental state using the United Kingdom Infant Questionnaire.
  • Participating registered chiropractors were recruited through the Royal College of Chiropractors annual meeting in January 2016, and 15 clinics and the Anglo-European College of Chiropractic University College teaching clinic volunteered to participate.

What They Found

  • 2001 mothers completed intake questionnaires and 1092 completed follow-up forms
  • Statistically significant ( P < .05) improvements were reported across all aspects of infant behavior studied, including feeding problems, sleep issues, excessive crying, problems with supine sleep position, infant pain, restricted cervical range of motion, and time performing prone positioning
  • Maternal ratings of depression, anxiety, and satisfaction with motherhood also demonstrated statistically significant improvement 
  • In total, 82% reported definite improvement of their infants on a global impression of change scale.
  • 95% reported feeling that the care was cost-effective
  • 90.9% rated their satisfaction 8 or higher on an 11-point scale.
  • Minor self-limiting side effects were reported but no adverse events.

Wrap It Up

The authors concluded, “mothers reported that chiropractic care for their infants was effective, safe, and cost-effective. Although the observational design makes it impossible to determine efficacy, the study’s findings indicate that, on average, the changes observed by mothers were positive and may be clinically relevant.”

Item #3

Our last one today is called “Effectiveness of chiropractic manipulation versus sham manipulation for recurrent headaches in children aged 7-14 years – a randomised clinical trial” by Lynge et. al. (3) and published in Chiropractic Manual Therapy in January of 2021….Oh, that’s a lot hot!!

Why They Did It

The authors stated objective here was to “investigate the effectiveness of chiropractic spinal manipulation versus sham manipulation in children aged 7-14 with recurrent headaches.”

How They Did It

  • It was a two-arm, single-blind, superiority randomized controlled trial.
  • It was performed at one chiropractic clinic with one pediatric specialty practice in Denmark, November 2015 to August 2020.
  • It included 199 children aged 7 to 14 years, with at least one episode of headache per week for the previous 6 months and at least one musculoskeletal dysfunction identified.
  • All participants received standard oral and written advice to reduce headaches
  • Children in the active treatment group received chiropractic spinal manipulation and children in the control group received sham manipulation for a period of 4 months
  • For outcome measures they used ‘Number of days with headache’, ‘pain intensity’ and ‘medication’ were reported weekly by text messages, and global perceived effect by text message after 4 months

What They Found

  • Chiropractic spinal manipulation resulted in significantly fewer days with headaches and better global perceived effect compared with a sham manipulation procedure.
  • There was no difference between groups for pain intensity during headache episodes.
  • Due to methodological shortcomings, no conclusions could be drawn about medication use.

Wrap It Up

The authors concluded “Chiropractic spinal manipulation resulted in fewer headaches and higher global perceived effect, with only minor side effects. It did not lower the intensity of the headaches. Since the treatment is easily applicable, of low cost and minor side effects, chiropractic spinal manipulation might be considered as a valuable treatment option for children with recurrent headaches.”

Alright, that’s it. Y’all be safe.

Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you.

Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store  Remember the evidence-informed brochures and posters at chiropracticforward.com. 

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The Message 

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: 

At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact 

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect 

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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About the Author & Host 

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

1. Pediatric Osteopathic Manipulative Medicine: A Scoping Review. Samantha DeMarsh, Anneliese Huntzinger, Alison Gehred, Joseph R. Stanek, Kathi J. Kemper, Jennifer A. Belsky

Pediatrics Feb 2021, 147 (2) e2020016162; DOI: 10.1542/peds.2020-016162

2. Joyce E. Miller, Heather A. Hanson, Mandy Hiew, Derek S. Lo Tiap Kwong, Zicheng Mok, Yun-Han Tee, “Maternal Report of Outcomes of Chiropractic Care for Infants”, J Man Physio Ther(42), 3, 2019, 167-176, https://doi.org/10.1016/j.jmpt.2018.10.005.

(https://www.sciencedirect.com/science/article/pii/S0161475418301453)

3. Lynge S, Dissing KB, Vach W, Christensen HW, Hestbaek L. Effectiveness of chiropractic manipulation versus sham manipulation for recurrent headaches in children aged 7-14 years – a randomised clinical trial. Chiropr Man Therap. 2021 Jan 7;29(1):1. doi: 10.1186/s12998-020-00360-3. PMID: 33413519; PMCID: PMC7792176.

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