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RACGP welcomes review of spinal manipulation on children


Morgan Liotta


12/03/2019 2:46:24 PM

President Dr Harry Nespolon is in favour of the review, although he believes a more wide-ranging evaluation is necessary.

Dr Harry Nespolon believes a broader review on the practice of spinal manipulation on children would be an opportunity to review other potentially harmful activities.
Dr Harry Nespolon believes a broader review on the practice of spinal manipulation on children would be an opportunity to review other potentially harmful activities.

Following the investigation of the chiropractor filmed manipulating the spine of a two-week-old baby, ‘Options for a nationally consistent approach to the regulation of spinal manipulation on children’ was on the agenda of last week’s Council of Australian Governments (COAG) Health Council meeting.
 
Health ministers agreed on the need for changes to the National Law to minimise potential risks from unsafe spinal manipulation performed on children. The council welcomed the Victorian proposal to commission an independent review of the practice of spinal manipulation on children under 12 years, with the findings reported to the COAG Health Council.
 
RACGP President Dr Harry Nespolon is in favour of the review, although he believes a more wide-ranging evaluation is necessary.
 
‘The RACGP welcomes a review of any sort of activities that are potentially dangerous to patients,’ Dr Nespolon told newsGP. ‘There needs to be a broad review about a lot of the activities of chiropractors – this is just one that has been highlighted by the activities of one chiropractor.
 
‘As far as I understand, there are lots of chiropractors out there who are doing spinal manipulation on children and babies, and that’s just one activity.’
 
Dr Nespolon believes a larger review would provide an opportunity to look at whether there are other complaints or concerns about the activities of chiropractors.
 
‘It should be a broader approach than just spinal manipulation of children,’ he said.
 
‘It’s clearly concerning that the senior chiropractors are defending this sort of activity when, as far as we know, there is no benefit and there are certainly potentially significant risks, particularly for young babies.
 
‘My question is – why are they being treated, anyway? If they’re being treated for crying, well, all babies cry.’
 
The independent review panel should ideally consist of ‘people with appropriate expertise and who are able to bring evidence to the table about the intuition of practicing spinal manipulation on children’, not a majority of chiropractors, according to Dr Nespolon.
 
‘It can’t be the chiropractors looking at themselves,’ he said.
 
Dr Nespolon recognises that although patients do not need a referral to see a chiropractor, the GP can make the decision based on the patient’s situation.
 
‘It’s up to the individual discretion of each GP knowing that there may not be a lot of evidence supporting the treatment that the chiropractors provide,’ he said.
 
‘Although the evidence is poor, there are certainly patients who benefit from having chiropractic treatments on their lower back, and for some individuals it might be beneficial.
 
‘Even though the studies show that basically rest is the most important thing you can do for these patients, people are still going to want to get some treatment.’
 
Health ministers will consider the outcomes of the independent review of spinal manipulation on children, and determine any further changes needed to protect the public.



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Dr Marita Jones   13/03/2019 7:05:27 AM

I also welcome the review into the chiropractic treatment of children and applaud the RACGP in supporting this review. If a parent is seeking chiropractic treatment we may be missing an area of need.
Parents of young children, especially new parents may present for a variety of reasons. It may be the spectrum of normal to difficult behaviours of a newborn, unsettled babies, colic, feeding difficulties or the more severe end of the spectrum with growth problems, allergies, reflux, parental exhaustion or mental illness. As GPs we have the unique opportunity to provide support to parents, empower them with knowledge of normal baby growth and development and advise or refer on medical issues as they arise. We also have a number referral pathways such as LCs, paediatricians, psychologists, psychiatrists and child health nurses.
There are also a number of non-pharmacological evidence based interventions for low back pain, not focusing on 'rest', that reflect current standards of practice.


vish   13/03/2019 8:03:59 AM

Chiropractors should not have an AHPRA registration. This issue alone legitimizes the quackery. Revoke their registrations and mandate their (as well as other alt medicine people e.g crystal healers, osteopaths n naturopaths etc) practice under a separate government body


Dr Peter J Strickland   13/03/2019 9:48:51 AM

This review of spinal manipulation by chiropractors is a no-brainer, and should have been done years ago. Manipulating young children's spines has never been a requirement of any of my patients, and certainly never cured any disease or disability. Subluxation in the spine does occur after falls and trauma from work and sport, and usually indicates some loss of supporting joint ligaments. Surprisingly, a lot of backpain is NOT relieved quickly by rest or manipulation, but rather from more work in the right way to heal muscles by simply bringing in an improved blood supply, and self-mobilising the affected areas of pain in the spine.


Sean   13/03/2019 11:52:05 PM

I’d love to see the studies showing “rest is the most important thing you can do for these patients”. Anything after about 1985 would say exactly the opposite. Early movement & minimising fear-avoidance behaviour is key.


Beau   14/03/2019 9:18:12 AM

To state that there is 'no evidence of benefit' is false. This recent BMJ systematic review for example. https://bmjopen.bmj.com/content/8/1/e019040 . But wait, are we are only 'evidence based' when it suits our own position? Nespolon is not aware of any evidence because he hasn't looked...


Dr Dave Jones   14/03/2019 9:20:36 PM

Thanks to Beau for the BMJ link which concludes: "Some small benefits were found, but whether these are meaningful to parents remains unclear as does the mechanisms of action."

Looking at the databases used and the types of studies (63% of the studies would provide Level IV or less evidence) and there are likely to be multiple biases within much of those data (from chiropractic and osteopathic literature, case series etc).

Given the "slight" improvement in crying time (which itself might show a subjective improvement through expectation bias once a parent has paid for a treatment)

Hardly solid evidence of benefit in my opinion.

My bigger concern with this and other "complementary therapies" is the way they are hawked around and missold on the basis of poor evidence to the vulnerable (e.g. at night to new mums in SCGH, WA).

I also find it appalling naturopaths can sell expensive placebos for $200 while GPs would be struck off for the same. This MUST be regulated.


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