Spinal manipulation or mobilisation for kids? No, stay away from both!

Press/Media: Expert Comment

Period22 Dec 2022

Media contributions


Media contributions

  • TitleSpinal manipulation or mobilisation for kids? No, stay away from both!
    Degree of recognitionInternational
    Media name/outletEdzard Ernst
    Media typeWeb
    DescriptionThe purpose of this review was to

    identify and map the available evidence regarding the effectiveness and harms of spinal manipulation and mobilisation for infants, children and adolescents with a broad range of conditions;
    identify and synthesise policies, regulations, position statements and practice guidelines informing their clinical use.
    Two reviewers independently screened and selected the studies, extracted key findings and assessed the methodological quality of included papers. A descriptive synthesis of reported findings was undertaken using a level-of-evidence approach.

    Eighty-seven articles were included. Their methodological quality varied. Spinal manipulation and mobilisation are being utilised clinically by a variety of health professionals to manage paediatric populations with

    adolescent idiopathic scoliosis (AIS),
    attention deficit hyperactivity disorder (ADHD),
    autism spectrum disorder (ASD),
    back/neck pain,
    breastfeeding difficulties,
    cerebral palsy (CP),
    dysfunctional voiding,
    excessive crying,
    infantile colic,
    kinetic imbalances due to suboccipital strain (KISS),
    nocturnal enuresis,
    otitis media,
    The descriptive synthesis revealed: no evidence to explicitly support the effectiveness of spinal manipulation or mobilisation for any condition in paediatric populations. Mild transient symptoms were commonly described in randomised controlled trials and on occasion, moderate-to-severe adverse events were reported in systematic reviews of randomised controlled trials and other lower-quality studies. There was strong to very strong evidence for ‘no significant effect’ of spinal manipulation for managing

    asthma (pulmonary function),
    nocturnal enuresis.
    There was inconclusive or insufficient evidence for all other conditions explored. There is insufficient evidence to draw conclusions regarding spinal mobilisation to treat paediatric populations with any condition.

    The authors concluded that, whilst some individual high-quality studies demonstrate positive results for some conditions, our descriptive synthesis of the collective findings does not provide support for spinal manipulation or mobilisation in paediatric populations for any condition. Increased reporting of adverse events is required to determine true risks. Randomised controlled trials examining effectiveness of spinal manipulation and mobilisation in paediatric populations are warranted.

    Perhaps the most important findings of this review relate to safety. They confirm (yet again) that there is only limited reporting of adverse events in this body of research. Six reviews, eight RCTs and five other studies made no mention of adverse events or harms associated with spinal manipulation. This, in my view, amounts to scientific misconduct. Four systematic reviews focused specifically on adverse events and harms. They revealed that adverse events ranged from mild to severe and even death.

    In terms of therapeutic benefit, the review confirms the findings from the previous research, e.g.:

    Green et al (Green S, McDonald S, Murano M, Miyoung C, Brennan S. Systematic review of spinal manipulation in children: review prepared by Cochrane Australia for Safer Care Victoria. Melbourne, Victoria: Victorian Government 2019. p. 1–67.) explored the effectiveness and safety of spinal manipulation and showed that spinal manipulation should – due to a lack of evidence and potential risk of harm – be recommended as a treatment of headache, asthma, otitis media, cerebral palsy, hyperactivity disorders or torticollis.
    Cote et al showed that evidence is lacking to support the use of spinal manipulation to treat non-musculoskeletal disorders.
    In terms of risk/benefit balance, the conclusion could thus not be clearer: no matter whether chiropractors, osteopaths, physiotherapists, or any other healthcare professionals propose to manipulate the spine of your child, DON’T LET THEM DO IT
    Producer/AuthorEdzard Ernst
    PersonsNikki Milne