The Study: Spinal manual therapy infants, children and adolescents: A systematic review and meta-analysis on treatment indication, technique and outcomes                  

The Facts:

a. They authors wished to study the safety and effectiveness of spinal manipulative therapy in infants, children and adolescents.

b. They conducted a systematic review of the literature.

c. They looked at 26 studies.

d. They searched the literature up to 2017.

e. They concluded: “Due to very low quality of the evidence, the effectiveness of gentle, low-velocity mobilizations in infants and HVLA manipulations in children and/or adolescents is uncertain.”

f. “Gentle, low-velocity spinal mobilizations seem to be a safe treatment technique. Although scarcely reported, HVLA manipulations in infants and young children could lead to severe harms.”

g. “Severe harms were relatively scarce, poorly described and likely to be associated with underlying missed pathology.”

h. “We encourage conduction of controlled studies that focus on the effectiveness of specific SMT techniques on spinal dysfunction, instead of concluding about SMT as a general treatment approach.”

Take Home:

“Gentle, low-velocity spinal mobilizations seem to be a safe treatment technique.”

“Severe harms were … likely to be associated with underlying missed pathology.”

Needed are: “…controlled studies that focus on the effectiveness of specific SMT techniques on spinal dysfunction, instead of concluding about SMT as a general treatment approach.”

 Reviewer's Comments:

First, I think we all agree that we all need to be cautious when administrating care. If manipulations can help then they can hurt. But one often overlooked point the authors bring is that the term spinal manipulative therapy [SMT] is way too broad to give the specific information we should be getting in scientific articles. There is a great difference in the care provided by a clinician who uses the Cox table on a patient and one who uses an Activator, just as there is a difference between the use of a drop table and the care provided by a clinician employing the Gonstead method. And while we’re at it, let’s use appropriate diagnostic tests to try to find underlying pathology. I recommend the interested reader take time to review the entire article. There’s a lot more than is possible to put into a review.

Reviewer: Roger Coleman DC

 Editor: Mark R. Payne DC

 Reference: Driehuis F, Hoogeboom TJ, Nijhuis-van der Sanden MWG, de Bie RA, Staal JB. Spinal manual therapy in infants, children and adolescents: A systematic review and metaanalysis on treatment indication, technique and outcomes. PLoS One. 2019 Jun 25;14(6):e0218940. doi: 10.1371/journal.pone.0218940. eCollection 2019.

 Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/31237917