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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Chickpeas vs Black Beans – Which is Healthier?
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Our Verdict
When comparing chickpeas to black beans, we picked the black beans.
Why?
They’re both great! But we consider the nutritional profile of black beans to be better:
In terms of macros, black beans have a little more protein, while chickpeas have more carbohydrates. Generally speaking, people are not usually short of carbs in their diet, so we’ll go with the one with more protein. Black beans also have more fiber, which is important for heart health and more.
In the category of micronutrients, black beans have twice as much potassium and twice as much calcium, as well as twice as much magnesium. Chickpeas, meanwhile are better for manganese and slightly higher in B vitamins, but B vitamins are everywhere (especially vitamin B5, pantothenic acid; that’s literally where its name comes from, it means “from everywhere”), so we don’t consider that as much of a plus as the black beans doubling up on potassium, calcium, and magnesium.
So, do enjoy both, but if you’re going to pick, or lean more heavily on one, we recommend the black beans
Further reading
See also:
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
- Easily Digestible Vegetarian Protein Sources
- What Matters Most For Your Heart? Eat More (Of This) For Lower Blood Pressure
Enjoy!
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Aging Well: Exercise, Diet, Relationships
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Questions and Answers at 10almonds
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This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! 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
I am interested in the following: Aging, Exercise, Diet, Relationships, Purpose, Lowering Stress
You’re going to love our Psychology Sunday editions of 10almonds!
You may particularly like some of these:
- Seriously Useful Communication Skills! ← this is about relationship stuff
- Lower Your Cortisol! (Here’s Why & How) ← about “the stress hormone”
- How To Set Your Anxiety Aside ← these methods work for stress too
(This coming Psychology Sunday will have a feature specifically on stress, so do make sure to read that when it comes out!)
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Chetna’s Healthy Indian – by Chetna Makan
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Indian food is wonderful—a subjective opinion perhaps, but a popular view, and one this reviewer certainly shares. And of course, cooking with plenty of vegetables and spices is a great way to get a lot of health benefits.
There are usually downsides though, such as that in a lot of Indian cookbooks, every second thing is deep-fried, and what’s not deep-fried contains an entire day or more’s saturated fat content in ghee, and a lot of sides have more than their fair share of sugar.
This book fixes all that, by offering 80 recipes that prioritize health without sacrificing flavor.
The recipes are, as the title suggests, vegetarian, though many are not vegan (yogurt and cheese featuring in many recipes). That said, even if you are vegan, it’s pretty easy to veganize those with the obvious plant-based substitutions. If you have soy yogurt and can whip up vegan paneer yourself (here’s our own recipe for that), you’re pretty much sorted.
The cookbook strikes a good balance of being neither complicated nor “did we really need a recipe for this?” basic, and delivers value in all of its recipes. The ingredients, often a worry for many Westerners, should be easily found if you have a well-stocked supermarket near you; there’s nothing obscure here.
Bottom line: if you’d like to cook more Indian food and want your food to be exciting without also making your blood pressure exciting, then this is an excellent book for keeping you well-nourished, body and soul.
Click here to check out Chetna’s Healthy Indian, and spice up your culinary repertoire!
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End the Insomnia Struggle – by Dr. Colleen Ehrnstrom and Dr. Alisha Brosse
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We’ve reviewed sleep books before, and we always try to recommend books that have something a little different than the rest, so what makes this one stand out?
While there is the usual quick overview of the basics that we’re sure you already know (sleep hygiene etc), most of the attention here is given to cold, hard clinical psychology… in a highly personalized way.
How, you may ask, can they personalize a book, that is the same for everyone?
The answer is, by guiding the reader through examining our own situation. With template logbooks, worksheets, and the like—for this reason we recommend getting a paper copy of the book, rather than the Kindle version, in case you’d like to use/photocopy those.
Essentially, reading this book is much like having your own psychologist (or two) to guide you through finding a path to better sleep.
The therapeutic approach, by the way, is a combination of Cognitive Behavioral Therapy (CBT) and Acceptance-Commitment Therapy (ACT), which work very well together here.
Bottom line: if you’ve changed your bedsheets and turned off your electronic devices and need something a little more, this book is the psychological “big guns” for removing the barriers between you and good sleep.
Click here to check out End the Insomnia Struggle, and end yours once and for all!
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How Useful Is Peppermint, Really?
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Peppermint For Digestion & Against Nausea
Peppermint is often enjoyed to aid digestion, and sometimes as a remedy for nausea, but what does the science say about these uses?
Peppermint and digestion
In short: it works! (but beware)
Most studies on peppermint and digestion, that have been conducted with humans, have been with regard to IBS, but its efficacy seems quite broad:
❝Peppermint oil is a natural product which affects physiology throughout the gastrointestinal tract, has been used successfully for several clinical disorders, and appears to have a good safety profile.❞
However, and this is important: if your digestive problem is GERD, then you may want to skip it:
❝The univariate logistic regression analysis showed the following risk factors: eating 1–2 meals per day (OR = 3.50, 95% CI: 1.75–6.98), everyday consumption of peppermint tea (OR = 2.00, 95% CI: 1.14–3.50), and eating one, big meal in the evening instead of dinner and supper (OR = 1.80, 95% CI: 1.05–3.11).
The multivariate analysis confirmed that frequent peppermint tea consumption was a risk factor (OR = 2.00, 95% CI: 1.08–3.70).❞
~ Dr. Jarosz & Dr. Taraszewska
Source: Risk factors for gastroesophageal reflux disease: the role of diet
Peppermint and nausea
Peppermint is also sometimes recommended as a nausea remedy. Does it work?
The answer is: maybe
The thing with nausea is it is a symptom with a lot of possible causes, so effectiveness of remedies may vary. But for example:
- Aromatherapy for treatment of postoperative nausea and vomiting ← no better than placebo
- The Effect of Combined Inhalation Aromatherapy with Lemon and Peppermint on Nausea and Vomiting of Pregnancy: A Double-Blind, Randomized Clinical Trial ← initially no better than placebo, then performed better on subsequent days
- The Effects of Peppermint Oil on Nausea, Vomiting and Retching in Cancer Patients Undergoing Chemotherapy: An Open Label Quasi-Randomized Controlled Pilot Study ← significant benefit immediately
Summary
Peppermint is useful against wide variety of gastrointestinal disorders, including IBS, but very definitely excluding GERD (in the case of GERD, it may make things worse)
Peppermint may help with nausea, depending on the cause.
Where can I get some?
Peppermint tea, and peppermint oil, you can probably find in your local supermarket (as well as fresh mint leaves, perhaps).
For the “heavy guns” that is peppermint essential oil, here’s an example product on Amazon for your convenience
Enjoy!
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Elderhood – by Dr. Louise Aronson
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Where does “middle age” end, and “old age” begin? By the United States’ CDC’s categorization, human life involves:
- 17 stages of childhood, deemed 0–18
- 5 stages of adulthood, deemed 18–60
- 1 stage of elderhood, deemed 60+
Isn’t there something missing here? Do we just fall off some sort of conveyor belt on our sixtieth birthdays, into one big bucket marked “old”?
Yesterday you were 59 and enjoying your middle age; today you have, apparently, the same medical factors and care needs as a 114-year-old.
Dr. Louise Aronson, a geriatrician, notes however that medical science tends to underestimate the differences found in more advanced old age, and underresearch them. That elders consume half of a country’s medicines, but are not required to be included in clinical trials. That side effects not only are often different than for younger adults, but also can cause symptoms that are then dismissed as “Oh she’s just old”.
She explores, mostly through personal career anecdotes, the well-intentioned disregard that is frequently given by the medical profession, and—importantly—how we might overcome that, as individuals and as a society.
Bottom line: if you are over the age of 60, love someone over the age of 60, this is a book for you. Similarly if you and/or they plan to live past the age of 60, this is also a book for you.
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