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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Lies I Taught in Medical School – by Dr. Robert Lufkin
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There seems to be a pattern of doctors who practice medicine one way, get a serious disease personally, and then completely change their practice of medicine afterwards. This is one of those cases.
Dr. Lufkin here presents, on a chapter-by-chapter basis, the titularly promised “lies” or, in more legally compliant speak (as he acknowledges in his preface), flawed hypotheses that are generally taught as truths. In many cases, the “lie” is some manner of “xyz is normal and nothing to worry about”, and/or “there is nothing to be done about xyz; suck it up”.
The end result of the information is not complicated—enjoy a plants-forward whole foods low-carb diet to avoid metabolic diseases and all the other things to branch off from same (Dr. Lufkin makes a fair case for metabolic disease leading to a lot of secondary diseases that aren’t considered metabolic diseases per se). But, the journey there is actually important, as it answers a lot of questions that are much less commonly understood, and often not even especially talked-about, despite their great import and how they may affect health decisions beyond the dietary. Things like understanding the downsides of statins, or the statistical models that can be used to skew studies, per relative risk reduction and so forth.
Bottom line: this book gives the ins and outs of what can go right or wrong with metabolic health and why, and how to make sure you don’t sabotage your health through missing information.
Click here to check out Lies I Taught In Medical School, and arm yourself with knowledge!
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Escape Self-Sabotage
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Stop Making The Same Mistakes
It’s easy to think that a self-destructive cycle is easy to avoid if you have no special will to self-destruction. However, the cycle is sneaky.
It’s sneaky because it can be passive, and/or omissions rather than actions, procrastinations rather than obvious acts of impulse, and so forth.
So, they’re often things that specifically aren’t there to see.
How to catch them
How often do you think “I wish I had [done xyz]” or “I wish I had [done yxz] sooner”?
Now, how often have you thought that about the same thing more than once? For example, “I should have kept up my exercise”.
For things like this, habit-trackers are a great way to, well, keep track of habits. If for example you planned to do a 10-minute exercise session daily but you’ve been postponing it since you got distracted on January the 2nd, then it’ll highlight that. See also:
How To Really Pick Up (And Keep!) Those Habits
Speaking of habits, this goes for other forms of procrastination, too. For example, if you are always slow to get medical check-ups, or renew your prescriptions, or get ready for some regularly-occurring thing in your schedule, then set a reminder in your preferred way (phone app, calendar on the wall, whatever) and when the appointed time arrives (to book the check-up, renew the prescription, do your taxes, whatever), do it on the day you set your reminder for, as a personal rule for you that you keep to, barring extreme calamity.
By “extreme calamity” we mean less “running late today” and more “house burned down”.
Digital traps
Bad habits can be insidious in other ways too, like getting sucked into social media scrolling (it is literally designed to do that to you; you are not immune modern programming hijacking evolutionary dopamine responses).
Setting a screentime limit (you can specify “just these apps” if you like) will help with this. On most devices, this feature includes a sticky notification in the notification bar, that’ll remind you “27 out of 30 minutes remaining” or whatever you set it for. That’ll remind you to do what you went there to do, instead of getting caught in the endless scroll (and if you went there to just browse, to do so briefly).
Here’s how to set that:
Instructions for iOS devices | Instructions for Android devices
Oh, and on the topic of social media? If you find yourself getting caught up in unproductive arguments on the Internet, try the three-response rule:
- You reply; they reply (no progress made)
- You reply; they reply (still no progress made)
- You reply; they reply (still yet no progress made)
You reply just one more time: “I have a personal rule that if I’m arguing on the Internet and no progress has been made after three replies, I don’t reply further—I find this is helpful to avoid a lot of time lost to pointless arguing that isn’t going anywhere. Best wishes.”
(and then stick to it, no matter how they try to provoke you; best is to just not look until at least the next day)
When “swept up in love” gets to one of those little whirlpools…
The same works in personal relationships, by the way. If for example you are arguing with a loved one and not making progress, it can be good if you both have a pre-arranged agreement that either of you can, up to once on any given day, invoke a “time-out” (e.g. 30 minutes, but you agree the time between you when you first make this standing policy) during which you will both keep out of the other’s way, and come back with a more productive head on (remembering that things go best when it’s you both vs the problem, rather than vs each other).
See also:
Seriously Useful Communication Skills: Conflict Resolution
What if the self-sabotaging cycle is active and apparent?
Well, that is less sneaky, but certainly no less serious, and sometimes moreso. An obvious example is drinking too much; this is often cyclical in nature. We wrote about this one previously:
That article’s alcohol-specific, but the same advices go for other harmful activities, including other substance abuse (which in turn includes binge-eating), as well psychological addictions (such as gambling, for example).
Finally…
If your destructive cycle is more of a rut you’ve got stuck in, a common advice is to change something, anything, to get out of the rut.
That can be very bad advice! Because sometimes the change you go for is absolutely not the change that was needed, and is rather just cracking under pressure and doing something impulsive.
Here’s one way to actively get out of a slump:
Behavioral Activation Against Depression & Anxiety
Note: you do not have to be depressed or anxious to do this. But the point is, it’s a tool you can use even if you are depressed and/or anxious, so it’s a good thing to try for getting out of most kinds of slumps.
And really finally, here’s a resource for, well, the title speaks for itself:
When You Know What You “Should” Do (But Knowing Isn’t The Problem)
Take care!
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Vitamin C (Drinkable) vs Vitamin C (Chewable) – Which is Healthier?
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Our Verdict
When comparing vitamin C (drinkable) to vitamin C (chewable), we picked the drinkable.
Why?
First let’s look at what’s more or less the same in each:
- The usable vitamin C content is comparable
- The bioavailability is comparable
- The additives to hold it together are comparable
So what’s the difference?
With the drinkable, you also drink a glass of water
If you’d like to read more about how to get the most out of the vitamins you take, you can do so here:
Are You Wasting Your Vitamins? Maybe, But You Don’t Have To
If you’d like to get some of the drinkable vitamin C, here’s an example product on Amazon
Enjoy!
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‘It’s okay to poo at work’: new health campaign highlights a common source of anxiety
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For most people, the daily or near-daily ritual of having a bowel motion is not something we give a great deal of thought to. But for some people, the need to do a “number two” in a public toilet or at work can be beset with significant stress and anxiety.
In recognition of the discomfort people may feel around passing a bowel motion at work, the Queensland Department of Health recently launched a social media campaign with the message “It’s okay to poo at work”.
The campaign has gained significant traction on Instagram and Facebook. It has been praised by health and marketing experts for its humorous handling of a taboo topic.
A colourful Instagram post is accompanied by a caption warning of the health risks of “holding it in”, including haemorrhoids and other gastrointestinal problems. The caption also notes:
If you find it extremely difficult to poo around other people, you might have parcopresis.
Queensland Health/Instagram What is parcopresis?
Parcopresis, sometimes called “shy bowel”, occurs when people experience a difficulty or inability to poo in public toilets due to fear of perceived scrutiny by others.
People with parcopresis may find it difficult to go to the toilet in public places such as shopping centres, restaurants, at work or at school, or even at home when friends or family are around.
They may fear being judged by others about unpleasant smells or sounds when they have a bowel motion, or how long they take to go, for example.
Living with a gastrointestinal condition (at least four in ten Australians do) may contribute to parcopresis due to anxiety about the need to use a toilet frequently, and perceived judgment from others when doing so. Other factors, such as past negative experiences or accessibility challenges, may also play a role.
Some people may feel uncomfortable about using the toilet at work. Motortion Films/Shutterstock For sufferers, anxiety can present in the form of a faster heart rate, rapid breathing, sweating, muscle tension, blushing, nausea, trembling, or a combination of these symptoms. They may experience ongoing worry about situations where they may need to use a public toilet.
Living with parcopresis can affect multiple domains of life and quality of life overall. For example, sufferers may have difficulties relating to employment, relationships and social life. They might avoid travelling or attending certain events because of their symptoms.
How common is parcopresis?
We don’t really know how common parcopresis is, partly due to the difficulty of evaluating this behaviour. It’s not necessarily easy or appropriate to follow people around to track whether they use or avoid public toilets (and their reasons if they do). Also, observing individual bathroom activities may alter the person’s behaviour.
I conducted a study to try to better understand how common parcopresis is. The study involved 714 university students. I asked participants to respond to a series of vignettes, or scenarios.
In each vignette participants were advised they were at a local shopping centre and they needed to have a bowel motion. In the vignettes, the bathrooms (which had been recently cleaned) had configurations of either two or three toilet stalls. Each vignette differed by the configuration of stalls available.
The rate of avoidance was just over 14% overall. But participants were more likely to avoid using the toilet when the other stalls were occupied.
Around 10% avoided going when all toilets were available. This rose to around 25% when only the middle of three toilets was available. Men were significantly less likely to avoid going than women across all vignettes.
For those who avoided the toilet, many either said they would go home to poo, use an available disabled toilet, or come back when the bathroom was empty.
Parcopresis at work
In occupational settings, the rates of anxiety about using shared bathrooms may well be higher for a few reasons.
For example, people may feel more self-conscious about their bodily functions being heard or noticed by colleagues, compared to strangers in a public toilet.
People may also experience guilt, shame and fear about being judged by colleagues or supervisors if they need to make extended or frequent visits to the bathroom. This may particularly apply to people with a gastrointestinal condition.
Reducing restroom anxiety
Using a public toilet can understandably cause some anxiety or be unpleasant. But for a small minority of people it can be a real problem, causing severe distress and affecting their ability to engage in activities of daily living.
If doing a poo in a toilet at work or another public setting causes you anxiety, be kind to yourself. A number of strategies might help:
- identify and challenge negative thoughts about using public toilets and remind yourself that using the bathroom is normal, and that most people are not paying attention to others in the toilets
- try to manage stress through relaxation techniques such as deep breathing and progressive muscle relaxation, which involves tensing and relaxing different muscles around the body
- engaging in gradual exposure can be helpful, which means visiting public toilets at different times and locations, so you can develop greater confidence in using them
- use grounding or distraction techniques while going to the toilet. These might include listening to music, watching something on your phone, or focusing on your breathing.
If you feel parcopresis is having a significant impact on your life, talk to your GP or a psychologist who can help identify appropriate approaches to treatment. This might include cognitive behavioural therapy.
Simon Robert Knowles, Associate Professor and Clinical Psychologist, Swinburne University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Savor: Mindful Eating, Mindful Life – by Thich Nhat Hanh and Dr. Lilian Cheung
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We’ve talked about mindful eating before at 10almonds, so here’s a book about it. You may wonder how much there is to say!
As it happens, there’s quite a bit. The authors, a Buddhist monk (Hanh) and a Harvard nutritionist (Dr. Cheung) explore the role of mindful eating in our life.
There is an expectation that we the reader want to lose weight. If we don’t, those parts of the book will be a “miss” for us, but still contain plenty of other value.
Most of the same advices can be applied equally to other aspects of health, in any case. A lot of that comes from the book’s Buddhist principles, including the notion that:
- We are experiencing suffering
- Suffering has a cause
- What has a cause can have an end
- The way to this end is mindfulness
As such, the process itself is also mindfulness all the way through:
- To be mindful of our suffering (and not let it become background noise to be ignored)
- To be mindful of the cause of our suffering (rather than dismissing it as just how things are)
- To be mindful of how to address that, and thus end the suffering (rather than despairing in inaction)
- To engage mindfully in the process of doing so (and thus not fall into the trap of thinking “job done”)
And, as for Dr. Cheung? She also has input throughout, with practical advice about the more scientific side of rethinking one’s diet.
Bottom line: this is an atypical book, and/but perhaps an important one. Certainly, at the very least it may be one to try if more conventional approaches have failed!
Click here to check out “Savor” on Amazon today, and get mindful!
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Feel Great, Lose Weight – by Dr. Rangan Chatterjee
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We all know that losing weight sustainably tends to be harder than simply losing weight. We know that weight loss needs to come with lifestyle change. But how to get there?
One of the biggest problems that we might face while trying to lose weight is that our “metabolic thermostat” has got stuck at the wrong place. Trying to move it just makes our bodies think we are starving, and everything gets even worse. We can’t even “mind over matter” our way through it with willpower, because our bodies will do impressive things on a cellular level in an attempt to save us… Things that are as extraordinary as they are extraordinarily unhelpful.
Dr. Rangan Chatterjee is here to help us cut through that.
In this book, he covers how our metabolic thermostat got stuck in the wrong place, and how to gently tease it back into a better position.
Some advices won’t be big surprises—go for a whole foods diet, avoiding processed food, for example. Probably not a shocker.
Others are counterintuitive, but he explains how they work—exercising less while moving more, for instance. Sounds crazy, but we assure you there’s a metabolic explanation for it that’s beyond the scope of this review. And there’s plenty more where that came from, too.
Bottom line: if your weight has been either slowly rising, or else very stable but at a higher point than you’d like, Dr. Chatterjee can help you move the bar back to where you want it—and keep it there.
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