Safety and Effectiveness of Pediatric Chiropractic
Safety and effectiveness are always on the mind of the pediatric chiropractor. The International Chiropractic Pediatric Association (ICPA) has performed many research studies that highlight the philosophy, science and art behind pediatric chiropractic and its safety. One of the more recent ICPA studies, “Ratings of perceived effectiveness, patient satisfaction and adverse events experienced by wellness chiropractic patients in a practice-based research network” (2019) aimed to quantify this.
Following chiropractic care, 87% of those responded defined their chiropractic care as “effective/very effective” while 11% assessed their care as “ineffective/very ineffective.” In the publication, it was noted that chiropractic wellness patients had a 95% satisfaction rate with care. Also interesting to note, is the reported prevalence of minor adverse events (minor and self-limiting in nature) from responders ranged from 6.3% to 11.3%.
Fallacies that the chiropractic adjustment is unsafe and/or harmful is usually the biggest contention from conventional medicine. These claims are not based on any real scientific measures though and are rooted more in misconceptions and bias.
In 2015, the Journal of Manipulative and Physiological Therapeutics published an article titled “Adverse Events Due to Chiropractic and Other Manual Therapies for Infants and Children: A Review of the Literature.” Reviewing 31 articles, they identified 12 articles with 15 severe adverse effects reported. Of those 15 cases, “3 deaths had been reported and were associated with various manual therapists; however, no deaths associated with chiropractic care were found in the literature to date.”
Of the deaths reported, the cases involved 1 physical therapist, 1 unknown practitioner, and 1 craniosacral therapist. Of the remaining 12 adverse events, “12 serious injuries were reported (7 chiropractors/doctors of chiropractic, 1 medical practitioner, 1 osteopath, 2 physical therapists, and 1 unknown practitioner).”
While one adverse event is always one too many, within the context that over 30 million chiropractic adjustments were performed worldwide in the year 2010, the statistical prevalence of an adverse event happening is extremely rare under chiropractic care.
The majority of adverse events that do occur have less to do with the chiropractic adjustment and more to do with underlying preexisting pathologies that were missed or ignored.
A thorough history and examination performed by the attending chiropractor and/or medical doctor can help identify anatomical or neurologic anomalies that might be contraindicated to any manual therapy or chiropractic adjustment.
The American Academy of Pediatrics recognizes the ever-increasing use and popularity of Complementary and Alternative Medicine, or CAM for short. From the medical perspective, Chiropractic fits under this umbrella term.
To better understand CAMs, the AAP spearheaded a Task Force that aimed to develop educational resources for medical physicians, patients and families. The Task Force outlined common types of CAM for children and their related therapies. One of the benchmarks investigated for each CAM healthcare provider was safety and effectiveness. Regarding chiropractic, the Task Force determined that “although anecdotal data suggests that severe complications are possible with chiropractic treatment of infants and children, such adverse effects seem to be rare.”
This determination was based on a systematic review study done by Dr. Sunita Vohra. While the study aimed to provide an objective review of CAMs, subjective underpinnings of “anti-chiropractic” beliefs were dotted throughout the review. Cognitive bias was on full display.
A time span of 1900 to 2004 was used as the search criteria for published research literature. Of the 13,916 articles initially searched for consideration, 164 articles were fully reviewed. Along with those studies, another 68 articles were reviewed from the reference lists of the 164 articles chosen. From that, they identified 13 studies that reported 14 adverse effects.
They then categorized those adverse effects as minor, moderate or severe and a fourth group as delayed diagnosis or treatment. Of those 14 cases, 10 were associated with chiropractic care. What is interesting to note, is that Dr. Vohra identified that they found 32 articles that did not identify an adverse event associated with pediatric chiropractic care. From this perspective, it could be reasoned that the literature supports chiropractic care is correlated with a lack of harm more than adverse effects.
The main chiropractic protest to this study is the ill-conceived categorization of reported adverse effects. Dr. Vohra grouped the adverse effects into three sets: minor, moderate and severe in nature. In actuality, the effects could all have been grouped as minor adverse effects that the chiropractor can address. In congruence with this faulty categorization, Dr. Vohra solely blamed chiropractic for any and all adverse effects experienced in the reported cases.
One of the main objections to pediatric chiropractic is the supposedly violent force associated with the adjustment and fracture potential. How much force is actually applied to a spine during an adjustment? Quantifying each and every adjustment can be a challenge but some studies do help put the adjustment force into comparative relation. Some of the more well-researched studies put the force in terms of Newtons.
A Newton is the International System of Units determined unit of force. One Newton is the force needed to accelerate one kilogram of mass at the rate of one meter per second squared in the direction of the applied force. 100 Newtons is about equivalent to 22.5 lbs of force. One study, “Forces of Commonly Used Chiropractic Techniques for Children” published in the Journal of Manipulative and Physiological Therapeutics in 2016, measured the force of an adjustment on the pediatric population follows as such:
Neonates and infants aged 0 to 2 months: 20 Newtons of force was used.
Infants and toddlers aged 3 months to 23 months: 28 N
Young children aged 2 years to 8 years: 60 N
Older children and young adults aged 8 to 18 years: 88 N
To put those numbers into perspective, a study “On the Biomechanics of Vaginal Birth and Common Sequelae” published in 2009 in the Annual Review of Biomedical Engineering, looked at the force used during the medical birthing process. Those forces investigated follows as such:
Intrauterine pressure: 16 N. This pressure measure the muscles of the uterus and their normal tone at rest. Even when a muscle is not contracted, it still maintains some tautness for integrity purposes.
Uterine contraction: 54 N. This contraction occurs naturally without conscious influence.
Volitional push: 120 N. This is when the mother actively bares down and pushes.
Vacuum device traction: 113 N. A vacuum traction is typically done 4 times during each contraction and push. So during a normal vaginal birth; which includes the intrauterine pressure, uterine contraction and volitional push, the force can add up to 190 N. When you add a vacuum device to the equation, the force can add up to 303 N
Obstetric forceps traction: 200 N. If we add that to the normal vaginal forces, the number jumps up to 390 N
One another study, “Tensile Failure of C2 Pedicles and the Subsequent Direct Repair in a Porcine Model” published in 2004 in the journal Spine looked at the force needed to fracture the pedicles of a cervical bone. Here they found it takes around 3,200 Newtons of force to fracture the cervical spine pedicles.
No force of a specific adjustment could ever come close to a fracture, an untruth that sometimes circulate around Chiropractic objectors. Furthermore, the baby spine is not fully ossified so how can you fracture something that is not fully ossified?
Since the advent of Chiropractic, being safe and effective has been at the forefront of thought and action when it comes to adjusting the young and old alike. Misconceptions about Chiropractic will always arise from those who don’t have all the facts, but to quote Fydor Dostoevsky, “Everything passes, only the truth remains.” For the past 120 years and for years to come, science will continue to highlight the truths of Chiropractic.
- Jarek Esarco, DC, CACCP
Related Blogs:
What is Pediatric Chiropractic?
What do Pediatric Chiropractors do?
Does Pediatric Chiropractic Work?
“My Pediatrician Said I Shouldn’t Take My Child to a Chiropractor, They are Dangerous!”
Adjusting Children: A New Age Niche or An Established Institute Foundation?