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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Kidney Beans vs White Beans – Which is Healthier?
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Our Verdict
When comparing kidney beans to white beans, we picked the white.
Why?
It was close, and each has its strengths! Bear in mind, these are very closely-related beans. But as we say, there are distinguishing factors…
In terms of macros, kidney beans have very slightly more fiber and white beans have very slightly more protein. But both are close enough in both of those things to call this a tie in this category.
When it comes to vitamins, there are two ways of looking at this:
- kidney beans have more of vitamins B1, B2, B3, B6, B9, C, and K, while white beans have more vitamin B5, E, and choline
- kidney beans have slightly more of some vitamins that don’t usually see a deficiency, while white beans have 31x more vitamin E
Nevertheless, we’re sticking by our usual method of noting that this is a 7:3 win for kidney beans in this category; we just wanted to note that in practical health terms, an argument can be made for white beans on the vitamin front too.
In the category of minerals, kidney beans have slightly more phosphorus, while white beans have more calcium, copper, iron, magnesium, manganese, potassium, selenium, and zinc. An easy win for white beans this time.
(In case you’re wondering about the margin on phosphorus, it was 0.2x more, so we’re not seeing a situation like white beans’ 31x more vitamin E)
In short: both are great and both have their strengths. Enjoy both, together if you like! But if we have to pick one, we’re going with white beans.
Want to learn more?
You might like to read:
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From Strength to Strength – by Dr. Arthur Brooks
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For most professions, there are ways in which performance can be measured, and the average professional peak varies by profession, but averages are usually somewhere in the 30–45 range, with a pressure to peak between 25–35.
With a peak by age 45 or perhaps 50 at the latest (aside from some statistical outliers, of course), what then to expect at age 50+? Not long after that, there’s a reason for mandatory retirement ages in some professions.
Dr. Brooks examines the case for accepting that rather than fighting it, and/but making our weaknesses into our strengths as we go. If our fluid intelligence slows, our accumulated crystal intelligence (some might call it “wisdom“) can make up for it, for example.
But he also champions the idea of looking outside of ourselves; of the importance of growing and fostering connections; giving to those around us and receiving support in turn; not transactionally, but just as a matter of mutualism of the kind found in many other species besides our own. Indeed, Dr. Brooks gives the example of a grove of aspen trees (hence the cover art of this book) that do exactly that.
The style is very accessible in terms of language but with frequent scientific references, so very much a “best of both worlds” in terms of readability and information-density.
Bottom line: if ever you’ve wondered at what age you might outlive your usefulness, this book will do as the subtitle suggests, and help you carve out your new place.
Click here to check out From Strength To Strength, and find yours!
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We looked at over 166,000 psychiatric records. Over half showed people were admitted against their will
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Picture two people, both suffering from a serious mental illness requiring hospital admission. One was born in Australia, the other in Asia.
Hopefully, both could be treated on a voluntary basis, taking into account their individual needs, preferences and capacity to consent. If not, you might imagine they should be equally likely to receive treatment against their will (known colloquially as being “sectioned” or “scheduled”).
However, our research published in British Journal of Psychiatry Open suggests this is not the case.
In the largest study globally of its kind, we found Australians are more likely to be treated in hospital for their acute mental illness against their will if they are born overseas, speak a language other than English or are unemployed.
What we did and what we found
We examined more than 166,000 episodes of voluntary and involuntary psychiatric care in New South Wales public hospitals between 2016 and 2021. Most admissions (54%) included at least one day of involuntary care.
Being brought to hospital via legal means, such as by police or via a court order, was strongly linked to involuntary treatment.
While our study does not show why this is the case, it may be due to mental health laws. In NSW, which has similar laws to most jurisdictions in Australia, doctors may treat a person on an involuntary basis if they present with certain symptoms indicating serious mental illness (such as hallucinations and delusions) which cause them to require protection from serious harm, and there is no other less-restrictive care available. Someone who has been brought to hospital by police or the courts may be more likely to meet the legal requirement of requiring protection from serious harm.
The likelihood of involuntary care was also linked to someone’s diagnosis. A person with psychosis or organic brain diseases, such as dementia and delirium, were about four times as likely to be admitted involuntarily compared to someone with anxiety or adjustment disorders (conditions involving a severe reaction to stressors).
However, our data suggest non-clinical factors contribute to the decision to impose involuntary care.
Compared with people born in Australia, we found people born in Asia were 42% more likely to be treated involuntarily.
People born in Africa or the Middle East were 32% more likely to be treated this way.
Overall, people who spoke a language other than English were 11% more likely to receive involuntary treatment compared to those who spoke English as their first language.
Some international researchers have suggested higher rates of involuntary treatment seen in people born overseas might be due to higher rates of psychotic illness. But our research found a link between higher rates of involuntary care in people born overseas or who don’t speak English regardless of their diagnosis.
We don’t know why this is happening. It is likely to reflect a complex interplay of factors about both the people receiving treatment and the way services are provided to them.
People less likely to be treated involuntarily included those who hold private health insurance, and those referred through a community health centre or outpatients unit.
Our findings are in line with international studies. These show higher rates of involuntary treatment among people from Black and ethnic minority groups, and people living in areas of higher socioeconomic disadvantage.
A last resort? Or should we ban it?
Both the NSW and Australian mental health commissions have called involuntary psychiatric care an avoidable harm that should only be used as a last resort.
Despite this, one study found Australia’s rate of involuntary admissions has increased by 3.4% per year and it has one of the highest rates of involuntary admissions in the world.
Involuntary psychiatric treatment is also under increasing scrutiny globally.
When Australia signed up to the UN Convention on the Rights of Persons with Disabilities, it added a declaration noting it would allow for involuntary treatment of people with mental illness where such treatments are “necessary, as a last resort and subject to safeguards”.
However, the UN has rejected this, saying it is a fundamental human right “to be free from involuntary detention in a mental health facility and not to be forced to undergo mental health treatment”.
Others question if involuntary treatment could ever be removed entirely.
Where to from here?
Our research not only highlights concerns regarding how involuntary psychiatric treatment is implemented, it’s a first step towards decreasing its use. Without understanding how and when it is used it will be difficult to create effective interventions to reduce it.
But Australia is still a long way from significantly reducing involuntary treatment.
We need to provide more care options outside hospital, ones accessible to all Australians, including those born overseas, who don’t speak English, or who come from disadvantaged communities. This includes intervening early enough that people are supported to not become so unwell they end up being referred for treatment via police or the criminal justice system.
More broadly, we need to do more to reduce stigma surrounding mental illness and to ensure poverty and discrimination are tackled to help prevent more people becoming unwell in the first place.
Our study also shows we need to do more to respect the autonomy of someone with serious mental illness to choose if they are treated. That’s whether they are in NSW or other jurisdictions.
And legal reform is required to ensure more states and territories more fully reflect the principal that people who have the capacity to make such decisions should have the right to decline mental health treatment in the same way they would any other health care.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.
Amy Corderoy, Medical doctor and PhD candidate studying involuntary psychiatric treatment, School of Psychiatry, UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Hearing loss is twice as common in Australia’s lowest income groups, our research shows
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Around one in six Australians has some form of hearing loss, ranging from mild to complete hearing loss. That figure is expected to grow to one in four by 2050, due in a large part to the country’s ageing population.
Hearing loss affects communication and social engagement and limits educational and employment opportunities. Effective treatment for hearing loss is available in the form of communication training (for example, lipreading and auditory training), hearing aids and other devices.
But the uptake of treatment is low. In Australia, publicly subsidised hearing care is available predominantly only to children, young people and retirement-age people on a pension. Adults of working age are mostly not eligible for hearing health care under the government’s Hearing Services Program.
Our recent study published in the journal Ear and Hearing showed, for the first time, that working-age Australians from lower socioeconomic backgrounds are at much greater risk of hearing loss than those from higher socioeconomic backgrounds.
We believe the lack of socially subsidised hearing care for adults of working age results in poor detection and care for hearing loss among people from disadvantaged backgrounds. This in turn exacerbates social inequalities.
Population data shows hearing inequality
We analysed a large data set called the Household, Income and Labour Dynamics in Australia (HILDA) survey that collects information on various aspects of people’s lives, including health and hearing loss.
Using a HILDA sub-sample of 10,719 working-age Australians, we evaluated whether self-reported hearing loss was more common among people from lower socioeconomic backgrounds than for those from higher socioeconomic backgrounds between 2008 and 2018.
Relying on self-reported hearing data instead of information from hearing tests is one limitation of our paper. However, self-reported hearing tends to underestimate actual rates of hearing impairment, so the hearing loss rates we reported are likely an underestimate.
We also wanted to find out whether people from lower socioeconomic backgrounds were more likely to develop hearing loss in the long run.
Hearing care is publicly subsidised for children.
mady70/ShutterstockWe found people in the lowest income groups were more than twice as likely to have hearing loss than those in the highest income groups. Further, hearing loss was 1.5 times as common among people living in the most deprived neighbourhoods than in the most affluent areas.
For people reporting no hearing loss at the beginning of the study, after 11 years of follow up, those from a more deprived socioeconomic background were much more likely to develop hearing loss. For example, a lack of post secondary education was associated with a more than 1.5 times increased risk of developing hearing loss compared to those who achieved a bachelor’s degree or above.
Overall, men were more likely to have hearing loss than women. As seen in the figure below, this gap is largest for people of low socioeconomic status.
Why are disadvantaged groups more likely to experience hearing loss?
There are several possible reasons hearing loss is more common among people from low socioeconomic backgrounds. Noise exposure is one of the biggest risks for hearing loss and people from low socioeconomic backgrounds may be more likely to be exposed to damaging levels of noise in jobs in mining, construction, manufacturing, and agriculture.
Lifestyle factors which may be more prevalent in lower socioeconomic communities such as smoking, unhealthy diet, and a lack of regular exercise are also related to the risk of hearing loss.
Finally, people with lower incomes may face challenges in accessing timely hearing care, alongside competing health needs, which could lead to missed identification of treatable ear disease.
Why does this disparity in hearing loss matter?
We like to think of Australia as an egalitarian society – the land of the fair go. But nearly half of people in Australia with hearing loss are of working age and mostly ineligible for publicly funded hearing services.
Hearing aids with a private hearing care provider cost from around A$1,000 up to more than $4,000 for higher-end devices. Most people need two hearing aids.
Hearing loss might be more common in low income groups because they’re exposed to more noise at work.
Dmitry Kalinovsky/ShutterstockLack of access to affordable hearing care for working-age adults on low incomes comes with an economic as well as a social cost.
Previous economic analysis estimated hearing loss was responsible for financial costs of around $20 billion in 2019–20 in Australia. The largest component of these costs was productivity losses (unemployment, under-employment and Jobseeker social security payment costs) among working-age adults.
Providing affordable hearing care for all Australians
Lack of affordable hearing care for working-age adults from lower socioeconomic backgrounds may significantly exacerbate the impact of hearing loss among deprived communities and worsen social inequalities.
Recently, the federal government has been considering extending publicly subsidised hearing services to lower income working age Australians. We believe reforming the current government Hearing Services Program and expanding eligibility to this group could not only promote a more inclusive, fairer and healthier society but may also yield overall cost savings by reducing lost productivity.
All Australians should have access to affordable hearing care to have sufficient functional hearing to achieve their potential in life. That’s the land of the fair go.
Mohammad Nure Alam, PhD Candidate in Economics, Macquarie University; Kompal Sinha, Associate Professor, Department of Economics, Macquarie University, and Piers Dawes, Professor, School of Health and Rehabilitation Sciences, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Why are people on TikTok talking about going for a ‘fart walk’? A gastroenterologist weighs in
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“Fart walks” have become a cultural phenomenon, after a woman named Mairlyn Smith posted online a now-viral video about how she and her husband go on walks about 60 minutes after dinner and release their gas.
Smith, known on TikTok as @mairlynthequeenoffibre and @mairlynsmith on Instagram, has since appeared on myriad TV and press interviews extolling the benefits of a fart walk. Countless TikTok and Instagram users and have now shared their own experiences of feeling better after taking up the #fartwalk habit.
So what’s the evidence behind the fart walk? And what’s the best way to do it?
CandyBox Images/Shutterstock Exercise can help get the gas out
We know exercise can help relieve bloating by getting gas moving and out of our bodies.
Researchers from Barcelona, Spain in 2006 asked eight patients complaining of bloating, seven of whom had irritable bowel syndrome, to avoid “gassy” foods such as beans for two days and to fast for eight hours before their study.
Each patient was asked to sit in an armchair, in order to avoid any effects of body position on the movement of gas. Gas was pumped directly into their small bowel via a thin plastic tube that went down their mouth, and the gas expelled from the body was collected into a bag via a tube placed in the rectum. This way, the researchers could determine how much gas was retained in the gut.
The patients were then asked to pedal on a modified exercise bike while remaining seated in their armchairs.
The researchers found that much less gas was retained in the patients’ gut when they exercised. They determined exercise probably helped the movement and release of intestinal gas.
Walking may have another bonus; it may trigger a nerve reflex that helps propel foods and gas contents through the gut.
Walking can also increase internal abdominal pressure as you use your abdominal muscles to stay upright and balance as you walk. This pressure on the colon helps to push intestinal gas out.
Proper fart walk technique
One study from Iran studied the effects of walking in 94 individuals with bloating.
They asked participants to carry out ten to 15 minutes of slow walking (about 1,000 steps) after eating lunch and dinner. They filled out gut symptom questionnaires before starting the program and again at the end of the four week program.
The researchers found walking after meals resulted in improvements to gut symptoms such as belching, farting, bloating and abdominal discomfort.
Now for the crucial part: in the Iranian study, there was a particular way in which participants were advised to walk. They were asked to clasp hands together behind their back and to flex their neck forward.
The clasped hands posture leads to more internal abdominal pressure and therefore more gentle squeezing out of gas from the colon. The flexed neck posture decreases the swallowing of air during walking.
This therefore is the proper fart walk technique, based on science.
Could walking with your hands behind your back yield better or more farts? candy candy/Shutterstock What about constipation?
A fart walk can help with constipation.
One study involved middle aged inactive patients with chronic constipation, who did a 12 week program of brisk walking at least 30 minutes a day – combined with 11 minutes of strength and flexibility exercises.
This program, the researchers found, improved constipation symptoms through reduced straining, less hard stools and more complete evacuation.
It also appears that the more you walk the better the benefits for gut symptoms.
In patients with irritable bowel syndrome, one study increasing the daily step count to 9,500 steps from 4,000 steps led to a 50% reduction in the severity of their symptoms.
And just 30 minutes of a fart walk has been shown to improve blood sugar levels after eating.
Walking after eating can help keep your blood sugar levels under control. IndianFaces/Shutterstock What if I can’t get outside the house?
If getting outside the house after dinner is impossible, could you try walking slowly on a treadmill or around the house for 1,000 steps?
If not, perhaps you could borrow an idea from the Barcelona research: sit back in an armchair and pedal using a modified exercise bike. Any type of exercise is better than none.
Whatever you do, don’t be a couch potato! Research has found more leisure screen time is linked to a greater risk of developing gut diseases.
We also know physical inactivity during leisure time and eating irregular meals are linked to a higher risk of abdominal pain, bloating and altered bowel motions.
Try the fart walk today
It may not be for everyone but this simple physical activity does have good evidence behind it. A fart walk can improve common symptoms such as bloating, abdominal discomfort and constipation.
It can even help lower blood sugar levels after eating.
Will you be trying a fart walk today?
Vincent Ho, Associate Professor and clinical academic gastroenterologist, Western Sydney University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Marathons in Mid- and Later-Life
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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
We had several requests pertaining to veganism, meatless mondays, and substitutions in recipes—so we’re going to cover those on a different day!
As for questions we’re answering today…
Q: Is there any data on immediate and long term effects of running marathons in one’s forties?
An interesting and very specific question! We didn’t find an overabundance of studies specifically for the short- and long-term effects of marathon-running in one’s 40s, but we did find a couple of relevant ones:
The first looked at marathon-runners of various ages, and found that…
- there are virtually no relevant running time differences (p<0.01) per age in marathon finishers from 20 to 55 years
- the majority of middle-aged and elderly athletes have training histories of less than seven years of running
From which they concluded:
❝The present findings strengthen the concept that considers aging as a biological process that can be considerably speeded up or slowed down by multiple lifestyle related factors.❞
See the study: Performance, training and lifestyle parameters of marathon runners aged 20–80 years: results of the PACE-study
The other looked specifically at the impact of running on cartilage, controlled for age (45 and under vs 46 and older) and activity level (marathon-runners vs sedentary people).
The study had the people, of various ages and habitual activity levels, run for 30 minutes, and measured their knee cartilage thickness (using MRI) before and after running.
They found that regardless of age or habitual activity level, running compressed the cartilage tissue to a similar extent. From this, it can be concluded that neither age nor marathon-running result in long-term changes to cartilage response to running.
Or in lay terms: there’s no reason that marathon-running at 40 should ruin your knees (unless you are doing something wrong).
That may or may not have been a concern you have, but it’s what the study looked at, so hey, it’s information.
Here’s the study: Functional cartilage MRI T2 mapping: evaluating the effect of age and training on knee cartilage response to running
Q: Information on [e-word] dysfunction for those who have negative reactions to [the most common medications]?
When it comes to that particular issue, one or more of these three factors are often involved:
- Hormones
- Circulation
- Psychology
The most common drugs (that we can’t name here) work on the circulation side of things—specifically, by increasing the localized blood pressure. The exact mechanism of this drug action is interesting, albeit beyond the scope of a quick answer here today. On the other hand, the way that they work can cause adverse blood-pressure-related side effects for some people; perhaps you’re one of them.
To take matters into your own hands, so to speak, you can address each of those three things we just mentioned:
Hormones
Ask your doctor (or a reputable phlebotomy service) for a hormone test. If your free/serum testosterone levels are low (which becomes increasingly common in men over the age of 45), they may prescribe something—such as testosterone shots—specifically for that.
This way, it treats the underlying cause, rather than offering a workaround like those common pills whose names we can’t mention here.
Circulation
Look after your heart health; eat for your heart health, and exercise regularly!
Cold showers/baths also work wonders for vascular tone—which is precisely what you need in this matter. By rapidly changing temperatures (such as by turning off the hot water for the last couple of minutes of your shower, or by plunging into a cold bath), your blood vessels will get practice at constricting and maintaining that constriction as necessary.
Psychology
[E-word] dysfunction can also have a psychological basis. Unfortunately, this can also then be self-reinforcing, if recalling previous difficulties causes you to get distracted/insecure and lose the moment. One of the best things you can do to get out of this catch-22 situation is to not worry about it in the moment. Depending on what you and your partner(s) like to do in bed, there are plenty of other equally respectable options, so just switch track!
Having a conversation about this in advance will probably be helpful, so that everyone’s on the same page of the script in that eventuality, and it becomes “no big deal”. Without that conversation, misunderstandings and insecurities could arise for your partner(s) as well as yourself (“aren’t I desirable enough?” etc).
So, to recap, we recommend:
- Have your hormones checked
- Look after your circulation
- Make the decision to have fun!
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