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Colic and Chiropractic

Prior to having children myself I really didn't comprehend the complexity of emotions that a crying baby induces in parents and mothers in particular.  Babies crying in cafes and planes didn't bother me beyond a passing sympathy for their accompanying parent.  However for some parents the seemingly constant crying of a young baby can be the most challenging aspect of parenthood, particularly so when compounded by postnatal depression in either or both parents.

By accepted definition, Colic, Infantile Colic, or Persistent Crying is commonly defined as "crying in an otherwise healthy infant for 3 or more hours per day, for 3 or more days per week" and the infant is considered "seriously fussy" if crying persists for more than 3 weeks (1).  I have been blessed with 4 beautiful children, none of whom would be defined as colicky, (due in part perhaps because as children of a paediatric chiropractor- they were all regularly adjusted since birth), but I certainly understand the anguish, helplessness, frustration, and physical and emotional exhaustion, that goes with a baby that is crying inconsolably, for no apparent reason.

Colic is the most common complaint for which parents seek professional advice in the first year of life (2,3) and it is thought that up to 21% of infants experience infantile colic.  What is perhaps more alarming is the understanding we now have that these infants, if left untreated, go into toddlerhood and school age with higher risks of difficult behaviour (4-8).  These children were described as being "bossy", unable to compromise, immature, emotionally labile ("explosive"), and having severe temper tantrums with uncontrolled activity levels.

Randomised trials have shown that chiropractic treatment for colicky infants, including spinal manipulative therapy, show beneficial results for infants who have colic (9,10,11).  Previously, the efficacy of some studies has been questioned regarding bias, however a recent single-blinded randomised controlled trial published by the British Medical Journal's Archives of Disease in Childhood found that the effect of chiropractic manual therapy on infantile colic is not significantly influenced by parental reporting bias (12), lending extra weight to previous studies.

Further, parents of children treated for colic by chiropractors reported fewer difficult behaviour and sleep patterns in their toddlers.

At Turramurra Chiropractic Centre, treatment for infantile colic consists of gentle finger pressure on spinal misalignments.  The pressure used is about what you can use on your eyelid and many babies sleep right through their chiropractic adjustments at Turramurra Chiropractic Centre.

1.Wessel MA et al. Paroxysmal fussing in infancy, sometimes called "colic". Pediatrics. 1954:14:421-35.

2.Crowcroft NS, Strachan DP. The social origins of infantile colic: questionnaire study covering 76,747 infants. BMJ 1997;314:1325-8.

3.Feedman SB et al. The crying infant: diagnostic testing and frequency of serious underlying disease.  Pediatrics 2009;123:841-8.

4.Rautava, P et al. Infantile colic: child and family three years later.  Pediatrics 1995;96:43-7.

5.Oberklaid F et al. Predicting school behaviour problems from temperament and other variables in infancy. Pediatrics 1993;91:113-20.

6.Forsyth BWC, Canny PF. Perceptions of vulnerability 3 years after problems of feeding and crying behaviour in early infancy. Pediatrics 1991;88:757-63.

7.Neu M, Keefe Mr. Characteristics of school age children who had colic as infants: mother's views. J Spec Pediatr Nurs 2002; 7:24-33.

8.Canivet C et al. Infantile COlic. Follow-up at four years of age: still ore "emotional." J Pediatr 2000;89:13-7.

9. Papousek M et al, editors. Disorders of behavioural and emotional regulation in the first years of life.  Early risks and interventions in the developing parent-infant relationship  Translated by Kenneth Kronenberg. Washington DC: Zero to Three National Centre for infants, Toddlers and Families; 2008. p 107.

10.Browning M, Miller J. Comparison of the short term effects of chiropractic spinal manipulation and occipital-sacral decompression in the treatment of infant colic: a single-blinded, randomised comparison trial. Clin Chiropr 2008;11:122-9.

11.Wiberg JMM et al. The short-term effects of chiropractic spinal manipulation and occipital-sacral decompression in the treatment of infant colic: a single-blinded, randomised controlled clinical trial with a blinded observer. J Manipulative Physiol Ther 1999;22:517-21.

12.Miller J, Newell N, Bolton J. Efficacy of manual therapy in infant colic: a pragmatic single-blind randomised controlled trial. Arch Dis Child 2012 97:A114.

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Iliotibial Band Syndrome

Iliotibial Band Syndrome is the most common cause of knee pain in runners and multi-sport athletes, by some estimates accounting for 12% of all running-related injuries.  Iliotibial band syndrome describes a condition whereby the iliotibial band rubs against a bony prominence at the outer aspect of the knee and typically causes inflammation and damage to local tissue.

ITBS is commonly labelled as an "overuse" injury.  However this is really a misnomer, as it is generally not the fact that the knee is being used too much but rather that there are predisposing biomechanical factors causing injury with even appropriate levels of training.

Most cases of iliotibial band syndrome settle well with appropriate chiropractic care.  This requires careful assessment byt the chiropractor to determine which factors have contributed to the development of the condition, with subsequent correction of these factors.

Chiropractors will make sure the joints in the entire lower extremity are functioning and moving properly.  This includes checking your feet, ankles, knee and hip.  Chiropractors want to identify the cause of your pain, not just treat the symptoms.

Chiropractic adjustments are performed to help restore normal biomechanics to the feet, ankles, hips and knee joint. It is important to manipulate and stretch capsular joint restrictions during the treatment phase.  This helps improve normal motion and promotes proper biomechanics as well as keeping the joint lubricated.

Stretching and strengthening exercises may also be used to correct muscle imbalances and treatment modalities such as ultrasound and massage may help calm inflammation in the ITB.

Most cases of ITB syndrome respond very well to chiropractic treatment and usually require only 4-6 weeks of care.

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Childhood Obesity

Around two-thirds of the population are overweight or obese.

For the first time in a century, we may be about to enter an era where children's life expectancy will drop. If current trends continue, obesity will shortly surpass smoking as the greatest cause of premature loss of life. The cycle of obesity that occurs when the problem is not tackled at an early age, most overweight or obese children become overweight or obese adults; overweight and obese adults are more likely to bring up overweight or obese children.

Many health problems can directly be linked to obesity and the effects of childhood obesity are too grim and serious to ignore. There are also emotional and psychological consequences that a child suffers by being overweight including bullying and aggression that can lead to issues with self-esteem and confidence.

  Australian Chiropractors are seeing an alarming increase in the number of young people presenting with physical problems more commonly associated with old age, as a result of obesity. When you carry a lot of weight your posture changes, your ability to move through space changes, your biomechanical movement isn't as good as it should be so all those joints have a lot more pressure on them. This extra pressure may lead to medial knee pain; hip and lower back pain, a rounding of the shoulders and headaches.

  Patients ask, “How can I exercise, lose weight and get healthy if the process hurts so much?” That’s where chiropractic care can help. It can help your body stay in alignment and reinforce your personal motives for weight-loss or more activity.

Chiropractic care is available to all ages and all sizes. Chiropractors provide hands-on, drug-free and non-surgical treatments, relying on the body’s inherent ability to heal. With weight-loss your centre of gravity changes, the demands on your lower back, hips, knees, ankles and feet have changed. The Chiropractor’s goal is to keep the child’s body in balance.

It is important that children as well as adults have a health check before they suddenly start doing vigorous exercise. When an adult or child has been living a more sedentary lifestyle the muscles, tendons and other soft tissues are not conditioned to sudden bouts of exercise and can be easily torn or damaged. Having a health check can make sure there are no underlying issues that could be preventing a child from exercising.

Making sure your child exercises for at least an hour a day, giving them healthy food, creating a restful sleeping environment and a bedtime ritual means that your child will be ready to sleep once they’ve been tucked in and it’s time to turn out the light. 

As Chiropractors, we promote health, wellness, balance and active lifestyles. We provide our patients with strategies to improve their postures and help make everyday life a little easier. We help increase motion and flexibility. Chiropractic care is a conservative, safe and effective option of healthcare.

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Is Chiropractic Care Safe for Children?

A couple times per year we have a slow news week in Sydney and the "Is Chiropractic Safe for Children" story arises again.  This happened recently with a blast of media attention and it needs to be addressed factually.

People consider the allopathic medical system to be relatively safe in the care of kids so let's use this as our benchmark.  A 2005 study published in Pediatrics medical journal suggested that adverse events occur in about an estimated 1% of children treated in hospital, and on average, 60% of these were preventable.(1)

Regarding medication usage in children, one of the largest studies of paediatric adverse drug events was published in Pediatrics in 2009. (2)  This paper tracked many aspects of paediatric medication usage and outcomes over an 11 year period in the USA.  A key statistic is the mean number of adverse drug event related visits to a medical outpatient clinic- 585,922.  This equates to approximately 1600 children per day in the USA being admitted to an outpatient clinic because the drug they were taking did not have the desired effects.  Although there are no readily available statistics for Australia, as with most aspects of healthcare, the western world tracks on a very similar path.

Let's look at deaths.  A study published in 2004, investigated paediatric patient safety in hospitals.  The authors review the discharge records of children 18 and under from hositals in 29 states in the USA throughout the year 2000, totaling 5.7 million discharges.  On review, they found 4483 deaths due to patient safety events, approximately 86 deaths per week. (3)

Lets have a look at the second largest health care profession in the world, chiropractic.  The most recent review of literature in 2011 reviewed the published articles to date describing adverse events associated with chiropractic paediatric manipulative therapy (PMT is the broadly descriptive term used in the literature).  The published literature suggests a mild adverse event (fussiness, irritability, for less than 24 hours, not requiring additional care) rate of 0.53%-1%.  This may readily be compared to osteopathic PMT with a reported rate of 9%, and medical practitioners utilising PMT under the auspices of "chiropractic therapy" have a reported rate of 6%. (4)

Are there any deaths?  According to published literature, there are two associated with a chiropractor following an adjustment- the most recent was in the 1960s.  This case was in France, (where legislative protection of the practice of chiropractic came into place only in the last decade) and the technique descriptor was that of rapid flexion, extension with rotation.  This is unlike any paediatric technique that has been taught in the past several decades (to the author's knowledge).  No serious adverse event has been reported in the past 21 years.

Based on evidence to date, chiropractic care for children is one of the safest healthcare interventions they can have.

Reproduced and paraphrased with kind permission from friend and colleague Dr Matthew Doyle, chiropractor.

1. Woods D, Thomas E, Holl J, et al. Adverse events and preventable adverse events in children.  Pediatrics 2005, 115:155-60.

2.Bourgeois FT, Mandl DK, Balim C, Shannon M. 2009. Pediatric adverse drug events in the outpatient setting: an 11-year national analysis.  Pediatrics. 124(4):3744-50.

3.Miller MR, Zahn C.  2004. Pediatric patient safety in hospitals: A national picture in 2000. Pediatrics, 113(6):1741-6.

4.Doyle M. 2011. Is chiropractic pediatric care safe? A best evidence topic. Clinical Chiropractic. 14, 97-105.