Pediatrics

Adolescent Idiopathic Scoliosis (AIS)

  • A 2019 systematic review appraised the evidence for the effectiveness of Schroth exercises compared to other non-surgical management to reduce the progression of AIS. Level II evidence suggests that Schroth exercises have a significant effect on reducing the Cobb angle and improving QOL in adolescents with idiopathic scoliosis.1
  • A 2019 review critically assessed the current literature on the effectiveness of manual therapy for AIS. Case reports and small-scale clinical trials of poor methodological quality clear conclusions. However, they provide a basis do further investigation of manual therapy techniques such as myofascial release and spinal manipulative techniques.2
  • A 2019 retrospective analysis of prospectively collected quality assurance data attained from a chiropractic clinical database. Patients ages 10-24 years demonstrated statistically and clinically significant improvement on the numeric rating scale (NRS) in all four spinal regions following chiropractic management that included manipulation, mobilization, soft tissue therapy, acupuncture, and other modalities within the chiropractic scope of practice.3
  • A 2017 systematic review found that conservative treatment should be tried when the curve is at a surgical threshold, before surgery is considered and that there is high quality evidence for conservative treatment of AIS. There is no high quality evidence demonstrating that surgical treatment is superior to conservative treatment for the management of AIS.4
  • A 2017 study evaluated the radiographic outcomes of 60 patients treated with a chiropractic scoliosis-specific exercise program AIS. 51.7% achieved curve correction and 38.3% achieved stabilization.5
  • A 2017 systematic review of clinical trials of spinal manipulative therapy (SMT) for AIS included 4 studies and found that the evidence was inconclusive, but favorable.6

Infants—General

  • A 2019 systematic review for the effectiveness and harms of specific SMT techniques for pediatric patients reviewed 26 included studies and concluded that gentle, low-velocity spinal mobilizations seem to be a safe treatment technique in infants, children and adolescents.7
  • A 2019 systematic review of manual therapy for pediatric patients reviewed 24 studies and found moderate positive evidence for low back pain, pulled elbow, and premature infants. Inconclusive unfavorable outcomes were found for scoliosis (osteopathic manipulative therapy) and torticollis (manual therapy). All other condition’s overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported.8
  • A 2018 systematic review to assess the effect of manual therapy interventions for healthy but unsettled, distressed and excessively crying infants reviewed 19 studies found moderate strength evidence for the effectiveness of manual therapy on: reduction in crying time. The risk of adverse events was low.9

Hip Pain

A 2017 retrospective chart review of 201 patients treated in a hospital-based sports medicine clinic compared patients receiving manual therapy and physical therapy to those receiving only physical therapy. It concluded that addition of manual therapy appears safe, but did not improve pain efficiency or patient adherence.10

Infant Torticollis

A 2019 review found that the available evidence is considered uncertain regarding the effectiveness of manipulation techniques for infant torticollis.11

References

  1. Burger M, Coetzee W, du Plessis LZ, et al. The effectiveness of Schroth exercises in adolescents with idiopathic scoliosis: A systematic review and meta-analysis. S Afr J Physiother. 2019;75(1):904. FREE FULL TEXT
  2. Lotan S, Kalichman L. Manual therapy treatment for adolescent idiopathic scoliosis. J Bodyw Mov Ther. 2019;23(1):189-193. FREE FULL TEXT
  3. Manansala C, Passmore S, Pohlman K, Toth A, Olin G. Change in young people’s spine pain following chiropractic care at a publicly funded healthcare facility in Canada. Complement Ther Clin Pract. 2019;35:301-307.
  4. Bettany-Saltikov J, Turnbull D, Ng SY, Webb R. Management of spinald deformities and evidence of treatment effectiveness. Open Orthop J. 2017;11:1521-1547. FREE FULL TEXT
  5. Morningstar MW, Dovorany B, Stitzel CJ, Siddiqui A. Chiropractic rehabilitation for adolescent idiopathic scoliosis: end-of-growth and skeletal maturity results. Clin Pract. 2017;7(1):911. FREE FULL TEXT
  6. Theroux J, Stomski N, Losco CD, Khadra C, Labelle H, Le May S. Spinal manipulative therapy for adolescent idiopathic scoliosis: a systematic review. J Manipulative Physiol Ther. 2017;40(6):452-458. FREE FULL TEXT
  7. 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 meta-analysis on treatment indication, technique and outcomes. PloS One. 2019;14(6):e0218940. FREE FULL TEXT
  8. Parnell Prevost C, Gleberzon B, Carleo B, Anderson K, Cark M, Pohlman KA. Manual therapy for the pediatric population: a systematic review. BMC Complement Altern Med. 2019;19(1):60. FREE FULL TEXT
  9. Carnes D, Plunkett A, Ellwood J, Miles C. Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses. BMJ Open. 2018;8(1):e019040. FREE FULL TEXT
  10. Galleher M, Crowe B, Selhorst M. The effectiveness of manual physical therapy interventions in pediatric patients with anterior hip pain: a retrospective study. J Man Manip Ther. 2017;25(5):288-293. FREE FULL TEXT
  11. Brurberg KG, Dahm KT, Kirkehei I. Manipulation techniques for infant torticollis. Tidsskr Nor Laegeforen. 2019;138(1). FREE FULL TEXT