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.

You wake up, stagger to the bathroom and gaze into the mirror. No, you’re not imagining it. You’ve developed face wrinkles overnight. They’re sleep wrinkles.

Sleep wrinkles are temporary. But as your skin loses its elasticity as you age, they can set in.

Here’s what you can do to minimise the chance of them forming in the first place.

How side-sleeping affects your face

Your skin wrinkles for a number of reasons, including ageing, sun damage, smoking, poor hydration, habitual facial expressions (such as grinning, pouting, frowning, squinting) and sleeping positions.

When you sleep on your side or stomach, your face skin is squeezed and crushed a lot more than if you sleep on your back. When you sleep on your side or stomach, gravity presses your face against the pillow. Your face skin is distorted as your skin is stretched, compressed and pulled in all directions as you move about in your sleep.

You can reduce these external forces acting on the face by sleeping on your back or changing positions frequently.

Doctors can tell which side you sleep on by looking at your face

In a young face, sleep wrinkles are transient and disappear after waking.

Temporary sleep wrinkles can become persistent with time and repetition. As we age, our skin loses elasticity (recoil) and extensibility (stretch), creating ideal conditions for sleep wrinkles or lines to set in and last longer.

The time spent in each sleeping position, the magnitude of external forces applied to each area of the face, as well as the surface area of contact with the pillow surface, also affects the pattern and rate of sleep wrinkle formation.

Skin specialists can often recognise this. People who favour sleeping on one side of their body tend to have a flatter face on their sleeping side and more visible sleep lines.

Can a night skincare routine avoid sleep wrinkles?

Collagen and elastin are two primary components of the dermis (inner layer) of skin. They form the skin structure and maintain the elasticity of skin.

Supplementing collagen through skincare routines to enhance skin elasticity can help reduce wrinkle formation.

Hyaluronic acid is a naturally occurring molecule in human bodies. It holds our skin’s collagen and elastin in a proper configuration, stimulates the production of collagen and adds hydration, which can help slow down wrinkle formation. Hyaluronic acid is one of the most common active ingredients in skincare creams, gels and lotions.

Moisturisers can hydrate the skin in different ways. “Occlusive” substances produce a thin layer of oil on the skin that prevents water loss due to evaporation. “Humectants” attract and hold water in the skin, and they can differ in their capacity to bind with water, which influences the degree of skin hydration.

Do silk pillowcases actually make a difference?

Silk pillowcases can make a difference in wrinkle formation, if they let your skin glide and move, rather than adding friction and pressure on a single spot. If you can, use silk sheets and silk pillows.

Studies have also shown pillows designed to reduce mechanical stress during sleep can prevent skin deformations. Such a pillow could be useful in slowing down and preventing the formation of certain facial wrinkles.

Sleeping on your back can reduce the risk of sleep lines, as can a nighttime routine of moisturising before sleep.

Otherwise, lifestyle choices and habits, such quitting smoking, drinking plenty of water, a healthy diet (eating enough vegetables, fruits, nuts, seeds, healthy fats, yogurt and other fermented foods) and regular use of sunscreens can help improve the appearance of the skin on our face.

Yousuf Mohammed, Dermatology researcher, The University of Queensland; Khanh Phan, Postdoctoral Research Fellow, Frazer Institute, The University of Queensland, and Vania Rodrigues Leite E. Silva, Honorary Associate Professor, Frazer Institute, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.