The evidence base for chiropractic treatment of musculoskeletal conditions in children and adolescents: The emperor's new suit?

Lise Hestbaek,Mette Jensen Stochkendahl

doi:10.1186/1746-1340-18-15

Abstract

Five to ten percent of chiropractic patients are children and adolescents. Most of these consult because of spinal pain, or other musculoskeletal complaints. These musculoskeletal disorders in early life not only affect the quality of children's lives, but also seem to have an impact on adult musculoskeletal health. Thus, this is an important part of the chiropractors' scope of practice, and the objective of this review is to assess the evidence base for manual treatment of musculoskeletal disorders in children and adolescents.Randomized, quasi-randomized and non-randomized clinical studies were included if they investigated the effect of manual therapy on musculoskeletal disorders in children and/or adolescents. The MEDLINE and MANTIS databases were searched, and studies published in English, Danish, Swedish or Norwegian were included.Only three studies were identified that in some way attempted to look at the effectiveness of manual therapy for children or adolescents with spinal problems, and none of these was a randomized controlled clinical trial. As for the rest of the musculoskeletal system, only one study of temporomandibular disorder was identified.With this review, we have detected a paradox within the chiropractic profession: Although the major reason for pediatric patients to attend a chiropractor is spinal pain, no adequate studies have been performed in this area. It is time for the chiropractic profession to take responsibility and systematically investigate the efficiency of joint manipulation of problems relating to the developing musculoskeletal system.

Highlights

All over the world, chiropractors treat a large variety of conditions in many ways
We have detected a paradox within the chiropractic profession: the major reason for pediatric patients to attend a chiropractor is spinal pain, no adequate studies have been performed in this area
The search in MANTIS resulted in one additional article [31]

Summary

Introduction

Chiropractors treat a large variety of conditions in many ways. the core area of chiropractic practice is the musculoskeletal system, with special focus on the spine. Surveys of chiropractic patients in different countries have shown that spinal pain is the most common reason for seeking chiropractic care with 64%-86% reporting spine-related symptoms [1,2,3,4,5]. Most of the patients in these surveys were adults, but chiropractors treat children all over the world the proportion of pediatric patients may vary between countries. A Danish survey showed that 64% of patients, aged 2 to 18, had primary complaints from the musculoskeletal system and 13% had headache as primary complaint [8]. There might be larger variety of symptoms among children and adolescents in chiropractic practice than among adult patients, but musculoskeletal disorders are by far the most prevalent complaints

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Conclusion