Spinal Manipulation May Cause Adverse Effects in Babies: Australia’s Peak Physiotherapy Body

The Australian Physiotherapy Association has advised parents against spinal manipulation for infants across all conditions, impairments, and spinal levels.
Spinal Manipulation May Cause Adverse Effects in Babies: Australia’s Peak Physiotherapy Body
Spinal manipulation has become a source of contention after the Chiropractic Board of Australia (CBA) gave the green light for chiropractors to resume the treatment for babies under the age of two. (Graeme Robertson/Getty Images)
Henry Jom

Australia’s peak physiotherapy body has advised parents against having their infant’s spine manipulated “for any reason,” saying that the potential risks are high.

This comes after the country’s peak chiropractic body updated its guidelines to permit chiropractors to resume manipulating the spines of children under the age of two. An interim ban had been in place for four years.

But following a health ministers meeting on June 14, the Chiropractic Board of Australia reinstated the ban on June 17 to “allow time for further consultation” with health ministers.

Spinal manipulation is defined as “any technique delivered by any health professional that involves a high velocity, low amplitude thrust beyond the physiological range of motion, impacting the spine, within the limits of anatomical integrity.”

Under the Health Practitioner Regulation National Law Act, spinal manipulation can only be administered by chiropractors, osteopaths, medical doctors, and physiotherapists.

“We do not recommend spinal manipulation for our paediatric clients, in particular our infants, because there is no evidence of a positive effect from utilising that treatment modality—and there is evidence of adverse reactions, and in some instances, they’re quite severe,” said Nikki Milne, a physiotherapist and associate professor of paediatric physiotherapy at Bond University, during a phone call with The Epoch Times on June 14.

“Some of the adverse reactions are mild, such as headaches, pain, some tingling, but some of them are quite severe, and there are things like vegetative states of infants, or fractured spines, or there is evidence of permanent paralysis in babies that have been manipulated, and there’s also some evidence of death.”

In an emailed statement, the Australian Physiotherapy Association (APA) said that “manipulation is not recommended for infants across all conditions, impairments, and spinal levels,” which aligns with the International Paediatric Spinal Manipulation taskforce’s position statement.

Concerns over the treatment method have also been expressed by the Australian Medical Association (AMA), and the Royal Australian College of General Practitioners (RACGP), which consider spinal manipulation of infants to be “irresponsible.”

“The spinal columns of young children and babies are very susceptible to injuries. Peer-reviewed literature strongly indicates that the risks of chiropractic care to children and adolescents far outweigh any health benefits,” RACGP President Nicole Higgins wrote in a statement to The Epoch Times.

These concerns have also prompted federal Health Minister Mark Butler to demand from the chiropractic board an “urgent explanation” as to why the suspension was overturned.

Meanwhile, Australian Chiropractors Association (ACA) President David Cahill had welcomed the revised guidelines, which allowed spinal manipulation for children under the age of two to resume, saying on June 14 (pdf) that it reinforced “the confidence the Australian public has in chiropractic care provided by registered ACA member chiropractors.”
Mr. Cahill said that of the 29,599 online submissions made by Australian parents in a Safer Care Victoria review (pdf), almost 22,000 responses from parents found “not a single report of significant harm” occurred to a child receiving chiropractic care.

“In a particularly strong endorsement, 99.6 percent of those parental submissions affirmed that chiropractic healthcare benefitted their child highlighting the exemplary safety record of chiropractic healthcare,” Mr. Cahill said.

But after reinstating the ban on June 17, chair of the Chiropractic Board of Australia Wayne Minter AM told The Epoch Times in a statement that both the board and health ministers will work together to “develop an evidence-based final policy on paediatric care that balances the paramount need to protect patients, with the right for parents and other patients to have a say in the care they choose.”

“The Board is committed to ensuring the public has access to, and receives, safe, ethical and competent care from registered chiropractors,” Mr. Minter said.

‘Weak Evidence’ Supporting the Effectiveness of Spinal Manipulation for Children: Review

In March 2019, the chiropractic board announced an interim suspension on spinal manipulation of children under the age of two. This ban occurred after a Melbourne-based chiropractor was filmed manipulating a two-week-old baby’s spine, hips, and collarbone.

Then Victorian health minister Jenny Mikakos described the footage as “deeply disturbing” and referred the chiropractor to the Australian Health Practitioner Regulation Agency (AHPRA) and the Chiropractic Board of Australia (CBA).

In the same month, the Safer Care Victoria review (pdf) found the evidence based on spinal manipulation in children to be “very poor.”

Additionally, the review found “weak evidence” for conditions that are commonly treated with spinal manipulation by chiropractors, such as colic, enuresis, back/neck pain, headache, asthma, otitis media, cerebral palsy, hyperactivity, and torticollis.

The review also recommended against spinal manipulation of children under 12 years old, “irrespective of the profession providing treatment.”

“That review itself was reviewed only in the last couple of years, and the same conclusion was reached,” federal health minister Mark Butler told reporters on June 14.
“I was quite shocked that the Board would overturn that pause, or that suspension of that type of practice, which has now been in place for five years.”

Evidence-Based Treatments Should Be Considered

Ms. Milne said that parents should seek evidence-based treatments for their children, as other alternatives may have a “high risk of harm.”

“I have concerns that a lot of the babies that are seeing chiropractors, or their parents who are taking them to see a chiropractor—they’re similar populations with similar conditions to what a number of other professions are seeing for a variety of non-musculoskeletal, or musculoskeletal conditions,” she said.

“For example, in the context of torticollis, there are really strong evidence-based guidelines, international guidelines, that the physiotherapy profession utilises that involve range of motion exercises, positioning babies in certain ways to increase their range of motion at their neck, and also for babies to actively build strength in the muscles that need strengthening while lengthening the muscles that need lengthening.

“And there is no need in conditions like that to be manipulating the spine when there’s evidence for other intervention forms.”

Henry Jom is a reporter for The Epoch Times, Australia, covering a range of topics, including medicolegal, health, political, and business-related issues. He has a background in the rehabilitation sciences and is currently completing a postgraduate degree in law. Henry can be contacted at [email protected]
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