Chiropractors have been banned again from manipulating babies’ spines. Here’s what the evidence actually says
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Chiropractors in Australia will not be able to perform spinal manipulation on children under the age of two once more, following health concerns from doctors and politicians.
But what is the spinal treatment at the centre of the controversy? Does it work? Is there evidence of harm?
We’re a team of researchers who specialise in evidence-based musculoskeletal health. I (Matt) am a registered chiropractor, Joshua is a registered physiotherapist and Giovanni trained as a physiotherapist.
Here’s what the evidence says.
Remind me, how did this all come about?
A Melbourne-based chiropractor posted a video on social media in 2018 using a spring-loaded device (known as the Activator) to manipulate the spine of a two-week-old baby suspended upside down by the ankles.
The video sparked widespread concerns among the public, medical associations and politicians. It prompted a ban on the procedure in young children. The Victorian health minister commissioned Safer Care Victoria to conduct an independent review of spinal manipulation techniques on children.
Recently, the Chiropractic Board of Australia reinstated chiropractors’ authorisation to perform spinal manipulation on babies under two years old. But this week, it backflipped, following heavy criticism from medical associations and politicians.
What is spinal manipulation?
Spinal manipulation is a treatment used by chiropractors and other health professionals such as doctors, osteopaths and physiotherapists.
It is an umbrella term that includes popular “back cracking” techniques.
It also includes more gentle forms of treatment, such as massage or joint mobilisations. These involve applying pressure to joints without generating a “cracking” sound.
Does spinal manipulation in babies work?
Several international guidelines for health-care professionals recommend spinal manipulation to treat adults with conditions such as back pain and headache as there is an abundance of evidence on the topic. For example, spinal manipulation for back pain is supported by data from nearly 10,000 adults.
For children, it’s a different story. Safer Care Victoria’s 2019 review of spinal manipulation found very few studies testing whether this treatment was safe and effective in children.
Studies were generally small and were of poor quality. Some of those small, poor-quality studies, suggest spinal manipulation provides a very small benefit for back pain, colic and potentially bedwetting – some common reasons for parents to take their child to see a chiropractor. But overall, the review found the overall body of evidence was very poor.
However, for most other children’s conditions chiropractors treat – such as headache, asthma, otitis media (a type of ear infection), cerebral palsy, hyperactivity and torticollis (“twisted neck”) – there did not appear to be a benefit.
The number of studies investigating the effectiveness of spinal manipulation on babies under two years of age was even smaller.
There was one high-quality study and two small, poor quality studies. These did not show an appreciable benefit of spinal manipulation on colic, otitis media with effusion (known as glue ear) or twisted neck in babies.
Is spinal manipulation on babies safe?
In terms of safety, most studies in the review found serious complications were extremely rare. The review noted one baby or child dying (a report from Germany in 2001 after spinal manipulation by a physiotherapist). The most common complications were mild in nature such as increased crying and soreness.
However, because studies were very small, they cannot tell us anything about the safety of spinal manipulation in a reliable way. Studies that are designed to properly investigate if a treatment is safe typically include thousands of patients. And these studies have not yet been done.
Why do people see chiropractors?
Safer Care Victoria also conducted surveys with more than 20,000 people living in Australia who had taken their children under 12 years old to a chiropractor in the past ten years.
Nearly three-quarters said that was for treatment of a child aged two years or younger.
Nearly all people surveyed reported a positive experience when they took their child to a chiropractor and reported that their child’s condition improved with chiropractic care. Only a small number of people (0.3%) reported a negative experience, and this was mostly related to cost of treatment, lack of improvement in their child’s condition, excessive use of x-rays, and perceived pressure to avoid medications.
Many of the respondents had also consulted their GP or maternity/child health nurse.
What now for spinal manipulation in children?
At the request of state and federal ministers, the Chiropractic Board of Australia confirmed that spinal manipulation on babies under two years old will continue to be banned until it discusses the issue further with health ministers.
Many chiropractors believe this is unfair, especially considering the strong consumer support for chiropractic care outlined in the Safer Care Victoria report, and the rarity of serious reported harms in children.
Others believe that in the absence of evidence of benefit and uncertainty around whether spinal manipulation is safe in children and babies, the precautionary principle should apply and children and babies should not receive spinal manipulation.
Ultimately, high quality research is urgently needed to better understand whether spinal manipulation is beneficial for the range of conditions chiropractors provide it for, and whether the benefit outweighs the extremely small chance of a serious complication.
This will help parents make an informed choice about health care for their child.
Matt Fernandez, Senior lecturer and researcher in chiropractic, CQUniversity Australia; Giovanni E. Ferreira, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, University of Sydney, and Joshua Zadro, NHMRC Emerging Leader Research Fellow, Sydney Musculoskeletal Health, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝How to jump start a inactive metabolism and keep it going? THANKYOU❞
The good news is, if you’re alive, your metabolism is active (it never stops!). So, it may just need perking up a little.
As for keeping it going, well, that’s what we’re here for! We’re all in favor of healthy longevity.
We’ll do a main feature soon on what we can do to influence our metabolism in either direction, but to give some quick notes here:
- A lot of our metabolism is influenced by genes and is unalterable (without modifying our genes, anyway)
- Metabolism isn’t just one thing—it’s many. And sometimes, parts of our metabolism can be much quicker or slower than others.
- When people talk about wanting a “faster metabolism”, they’re usually referring to fat-burning, and that’s just a small part of the picture, but we understand that it’s a focal point for many.
There really is enough material for a whole main feature on metabolic tweaks, though, so watch this space!
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Hungry? How To Beat Cravings
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The Science of Hunger, And How To Sate It
This is Dr. David Ludwig. That’s not a typo; he’s a doctor both ways—MD and PhD.
Henceforth we’ll just say “Dr. Ludwig”, though! He’s a professor in the Department of Nutrition at Harvard T.H. Chan School of Public Health, and director of the New Balance Foundation Obesity Prevention Center.
His research focuses on the effects of diet on hormones, metabolism, and body weight, and he’s one of the foremost experts when it comes to carbohydrates, glycemic load, and obesity.
Why are we putting on weight? What are we getting wrong?
Contrary to popular belief, Dr. Ludwig says, weight gain is not caused by a lack of exercise. In fact, people tend to overestimate how many calories are burned by exercise.
A spoonful of sugar may make the medicine go down, but it also contains 60 calories, and that’d take about 1,500 steps for the average person to burn off. Let’s put this another way:
If you walk 10,000 steps per day, that will burn off 400 calories. Still think you can exercise away that ice cream sundae or plate of fries?
Wait, this is interesting and all, but what does this have to do with hunger?
Why we get hungry
Two important things:
- All that exercise makes us hungry, because the more we exercise, the more the body speeds up our metabolism accordingly.
- Empty calories don’t just add weight themselves, they also make us hungrier
What are empty calories, and why do they make us hungrier?
Empty calories are calories that are relatively devoid of other nutrition. This especially means simple sugars (especially refined sugar), white flour and white flour products (quick-release starches), and processed seed oils (e.g. canola, sunflower, and friends).
They zip straight into our bloodstream, and our body sends out an army of insulin to deal with the blood sugar spike. And… that backfires.
Imagine a person whose house is a terrible mess, and they have a date coming over in half an hour.
They’re going to zoom around tidying, but they’re going to stuff things out of sight as quickly and easily as possible, rather than, say, sit down and Marie Kondo the place.
But superficially, they got the job done really quickly!
Insulin does similarly when overwhelmed by a blood sugar spike like that.
So, it stores everything as fat as quickly as possible, and whew, the pancreas needs a break now after all that exertion, and the blood is nice and free from blood sugars.
Wait, the blood is what now?
The body notices the low blood sugar levels, and it also knows you just stored fat so you must be preparing for starvation, and now the low blood sugar levels indicate starvation is upon us. Quick, we must find food if we want to survive! So it sends a hunger signal to make sure you don’t let the body starve.
You make a quick snack, and the cycle repeats.
Dr. Ludwig’s solution:
First, we need to break out of that cycle, and that includes calming down our insulin response (and thus rebuilding our insulin sensitivity, as our bodies will have become desensitized, after the equivalent of an air-raid siren every 40 minutes or so).
How to do that?
First, cut out the really bad things that we mentioned above.
Next: cut healthy carbs too—we’re talking unprocessed grains here, legumes as well, and also starchy vegetables (root vegetables etc). Don’t worry, this will be just for a short while.
The trick here is that we are resensitizing our bodies to insulin.
Keep this up for even just a week, and then gradually reintroduce the healthier carbs. Unprocessed grains are better than root vegetables, as are legumes.
You’re not going to reintroduce the sugars, white flour, canola oil, etc. You don’t have to be a puritan, and if you go to a restaurant you won’t undo all your work if you have a small portion of fries. But it’s not going to be a part of your general diet.
Other tips from Dr. Ludwig:
- Get plenty of high-quality protein—it’s good for you and suppresses your appetite
- Shop for success—make sure you keep your kitchen stocked with healthy easy snack food
- Nuts, cacao nibs, and healthy seeds will be your best friends and allies here
- Make things easy—buy pre-chopped vegetables, for example, so when you’re hungry, you don’t have to wait longer (and work more) to eat something healthy
- Do what you can to reduce stress, and also eat mindfully (that means paying attention to each mouthful, rather than wolfing something down while multitasking)
If you’d like to know more about Dr. Ludwig and his work, you can check out his website for coaching, recipes, meal plans, his blog, and other resources!
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Felt Time – by Dr. Marc Wittmann
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This book goes far beyond the obvious “time flies when you’re having fun / passes slowly when bored”, or “time seems quicker as we get older”. It does address those topics too, but even in doing so, unravels deeper intricacies within.
The author, a research psychologist, includes plenty of reference to actual hard science here, and even beyond subjective self-reports. For example, you know how time seems to slow down upon immediate apparent threat of violent death (e.g. while crashing, while falling, or other more “violent human” options)? We learn of an experiment conducted in an amusement park, where during a fear-inducing (but actually safe) plummet, subjective time slows down yes, but measures of objective perception and cognition remained the same. So much for adrenal superpowers when it comes to the brain!
We also learn about what we can change, to change our perception of time—in either direction, which is a neat collection of tricks to know.
The style is on the dryer end of pop-sci; we suspect that being translated from German didn’t help its levity. That said, it’s not scientifically dense either (i.e. not a lot of jargon), though it does have many references (which we like to see).
Bottom line: if you’ve ever wished time could go more quickly or more slowly, this book can help with that.
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6 Signs Of A Heart Attack… A Month In Advance
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Many people know the signs of a heart attack when it’s happening, but how about before it’s too late to avoid it?
The signs
- Unusual fatigue: persistent tiredness that doesn’t improve with rest
- Shortness of breath: unexplained breathlessness during light activities or rest, which can be caused by fluid buildup in the lungs (because the heart isn’t circulating blood as well as it should)
- Chest discomfort: pain, pressure, tightness, or aching in the chest due to reduced blood flow to the heart muscle—often occurring during physical exertion or emotional stress
- Frequent indigestion: means that heartburn could be heart-related! This is about persistently reoccurring discomfort or pain in the upper abdomen
- Sleep disturbances: difficulties falling asleep, staying asleep, or waking up abruptly
- Excessive sweating: unexplained cold sweats or sudden sweating without physical exertion or excessive heat, can be a response to the decreased oxygen levels caused by less efficient blood flow
Note: this is a list of warning signs, not a diagnostic tool. Any or even all of these could be caused by something else. Just, don’t ignore the signs and do get yourself checked out.
For more details on each of these, enjoy:
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From Cucumbers To Kindles
Q: Where do I get cucumber extract?
A: You can buy it from BulkSupplements.com (who, despite their name, start at 100g packs)
Alternatively: you want it as a topical ointment (for skin health) rather than as a dietary supplement (for bone and joint health), you can extract it yourself! No, it’s not “just juice cucumbers”, but it’s also not too tricky.
Click Here For A Quick How-To Guide!
Q: Tips for reading more and managing time for it?
A: We talked about this a little bit in yesterday’s edition, so you may have seen that, but aside from that:
- If you don’t already have one, consider getting a Kindle or similar e-reader. They’re very convenient, and also very light and ergonomic—no more wrist strain as can occur with physical books. No more eye-strain, either!
- Consider making reading a specific part of your daily routine. A chapter before bed can be a nice wind-down, for instance! What’s important is it’s a part of your day that’ll always, or at least almost always, allow you to do a little reading.
- If you drive, walk, run, or similar each day, a lot of people find that’s a great time to listen to an audiobook. Please be safe, though!
- If your lifestyle permits such, a “reading retreat” can be a wonderful vacation! Even if you only “retreat” to your bedroom, the point is that it’s a weekend (or more!) that you block off from all other commitments, and curl up with the book(s) of your choice.
Q: Any study tips as we approach exam season? A lot of the productivity stuff is based on working life, but I can’t be the only student!
A: We’ve got you covered:
- Be passionate about your subject! We know of no greater study tip than that.
- Find a willing person and lecture them on your subject. When one teaches, two learn!
- Your mileage may vary depending on your subject, but, find a way of studying that’s fun to you!
- If you can get past papers, get as many as you can, and use those as your “last minute” studying in the week before your exam(s). This will prime you for answering exam-style questions (and leverage state-dependent memory). As a bonus, it’ll also help ease any anxiety, because by the time of your exam it’ll be “same old, same old”!
Q: Energy drinks for biohacking, yea or nay?
A: This is definitely one of those “the dose makes the poison” things!
- Caffeine, in and of itself, can be healthy in moderation for most people.
- Taurine has assorted benefits at safe dosages:
- Other ingredients often have health benefits too.
But… The generally agreed safe dose of taurine is around 3g/day for most people; a standard Red Bull contains 1g.
That math would be simple, but… if you eat meat (including poultry or fish), that can also contain 10–950mg per 100g. For example, tuna is at the high end of that scale, with a standard 12oz (340g) tin already containing up to 3.23g of taurine!
And sweetened carbonated beverages in general have so many health issues that it’d take us a full article to cover them.
Short version? Enjoy in moderation if you must, but there are definitely better ways of getting the benefits they may offer.
Q: Best morning routine?
A: The best morning routine is whatever makes you feel most ready to take on your day!
This one’s going to vary a lot—one person’s morning run could be another person’s morning coffee and newspaper, for example.
In a nutshell, though, ask yourself these questions:
- How long does it take me to fully wake up in the morning, and what helps or hinders that?
- When I get out of bed, what do I really need before I can take on my day?
- If I could have the perfect morning, what would it look like?
- What can evening me do, to look after morning me’s best interests? (Semi-prepare breakfast ready? Lay out clothes ready? Running shoes? To-Do list?)
Q: I’m curious how much of these things you actually use yourselves, and are there any disagreements in the team? In a lot of places things can get pretty heated when it’s paleo vs vegan / health benefits of tea/coffee vs caffeine-abstainers / you need this much sleep vs rise and grinders, etc?
A: We are indeed genuinely enthusiastic about health and productivity, and that definitely includes our own! We may or may not all do everything, but between us, we probably have it all covered. As for disagreements, we’ve not done a survey, but if you take an evidence-based approach, any conflict will tend to be minimized. Plus, sometimes you can have the best of both!
- You could have a vegan paleo diet (you’d better love coconut if you do, though!
- There is decaffeinated coffee and tea (your taste may vary)
- You can get plenty of sleep and rise early (so long as an “early to bed, early to rise” schedule suits you!)
Interesting note: humans are social creatures on an evolutionary level. Evolution has resulted in half of us being “night owls” and the other half “morning larks”, the better to keep each other safe while sleeping. Alas, modern life doesn’t always allow us to have the sleep schedule that’d suit each of us best individually!
Have a question you’d like answered? Reply to this email, or use the feedback widget at the bottom! We always love to hear from you
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The Little-Known Truth…
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Myth-Buster, Myth-Buster, Bust Us A Myth (or three!)
Let’s can this myth for good
People think of “canned foods” as meaning “processed foods” and therefore bad. But the reality is it’s all dependent on what’s in the can (check the ingredients!). And as for nutrients?
Many canned fruits and vegetables contain more nutrients than fresh ones! This is because the way they’ve been stored preserves them better. For example:
- Canned tomatoes contain more bioavailable lycopene than fresh
- Canned spinach contains more bioavailable carotene than fresh
- Canned corn contains more bioavailable lutein than fresh
- The list goes on, but you get the idea!
Don’t Want To Take Our Word For It? Read The Scientific Paper Here!
Gaslight, Gymkeep, Girl-loss?
Many women and girls avoid doing weight-training as part of their exercise—or use only the smallest weights—to avoid “bulking up” and “looking like a man”.
Many men, meanwhile, wish it were that easy to bulk up!
The reality is that nobody, unless you have very rare genes, packs on a lot of muscle by accident. Even with the genes for it, it won’t happen unless you’re also eating for it!
Resistance-based strength training (such as lifting weights), is a great way for most people to look after an important part of their long-term health: bone density!
You can’t have strong muscles on weak bones, so strengthening the muscles cues the body to strengthen the bones. In short, your strength-training at age 45 or 55 (or earlier) could be what helps you avoid a broken hip at 65 or 75.
We’re Not Kidding, It Really Is That Important (Read The Study Here)!
Something doesn’t smell right about this
There’s been a big backlash against anti-perspirants and deodorants. The popular argument is that the aluminium in them causes cancer.
This led to many people buying “deodo-rocks”, crystal rocks that can be run under water and then rubbed on the armpits to deodorize “naturally”. But, those crystal rocks are actually alum crystals (guess what they contain…).
The belief that deodorants cause cancer came from studies done by applying deodorant to cells (like the canine kidney cells in this study) in petri dishes. So, assuming you don’t cut out your kidney and then spray it directly with the deodorant, the jury is still out!
A more recent systematic review sorted out quite clearly the ways in which aluminium was, or was not, harmful, and said:
❝Neither is there clear evidence to show use of Al-containing underarm antiperspirants or cosmetics increases the risk of Alzheimer’s Disease or breast cancer. Metallic Al, its oxides, and common Al salts have not been shown to be either genotoxic or carcinogenic.❞
Critical Reviews in Toxicology
…but also says that you should avoid eating aluminium while pregnant or breastfeeding. We hope you can resist the urge.
See The Summary For Yourself Here!
(actually the whole article is there, but we know you value condensed knowledge, so: the abstract at the top will probably tell you all you want to know!)
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