Evaluation of chiropractic management of pediatric patients with low back pain: a prospective cohort study
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Jill A Hayden1, Silvano A Mior, Marja J Verhoef
1Institute for Work and Health, 481 University Avenue, 8th Floor, Toronto M5G 2E9, Ontario, Canada.
Insights
Chiropractic care for pediatric low back pain (LBP) showed favorable outcomes, with significant improvement in most young patients. Chronic LBP cases were less responsive to treatment within six weeks.
Area of Science:
- Chiropractic care
- Pediatric orthopedics
- Musculoskeletal health
Background:
- Low back pain (LBP) affects approximately 50% of children, with 15% experiencing frequent pain.
- No prior studies have documented conservative treatments for childhood LBP.
Purpose of the Study:
- To describe chiropractic management of pediatric LBP.
- To evaluate outcomes and associated factors in children aged 4–18 years receiving chiropractic care.
Main Methods:
- Prospective cohort study of 54 pediatric patients with LBP treated by 15 chiropractors.
- Outcomes measured using visual analogue and subjective rating scales over a 6-week period.
Main Results:
- Nearly 90% of cases involved uncomplicated mechanical LBP, often diagnosed as lumbar facet dysfunction or subluxation.
- Significant improvement reported in 62% (visual analogue scale) and 87% (subjective scale) of patients.
- Chronic LBP was associated with a lower likelihood of response within the median treatment duration.
Conclusions:
- Chiropractic management appears effective and safe for pediatric LBP, with no reported complications.
- Further research is needed to compare chiropractic care with other treatments for childhood LBP.
Background:
Recent epidemiologic studies have estimated that the lifetime prevalence of low back pain (LBP) in children is approximately 50%, with almost 15% of children experiencing frequent or continual pain. A literature search revealed no published studies addressing conservative treatment of childhood LBP.
Objective:
To describe chiropractic management of LBP in patients between the ages of 4 and 18 years, as well as outcomes and factors associated with the outcomes.
Methods:
Prospective cohort study of consecutive pediatric patients with LBP seeing randomly selected chiropractors within the cities of Calgary, Alberta, and Toronto, Ontario, Canada. Follow-up data collection included the type and extent of treatment rendered and its outcome, which was measured with a 5-point subjective rating scale and a self-report pediatric visual analogue scale.
Results:
Fifteen chiropractors provided data on 54 consecutive pediatric patients with LBP. The average age of the patients was 13.1 years, 57% were male, 61% were acute, with 47% attributing onset to a traumatic event (most commonly sports-related); 24% reported an episode duration of greater than 3 months. Almost 90% of cases presented with uncomplicated mechanical LBP, most frequently diagnosed as lumbar facet dysfunction or subluxation. Patients were managed with manipulation, with a minority (7.7%) receiving some form of active management. "Important" improvement was seen in 62% and 87% on the visual analogue and subjective scales, respectively, within a 6-week course of management (Kaplan-Meier survival analysis). Patients with chronic LBP were less likely to respond within the median number of treatments (relative risk = 2.1).
Conclusions:
Patients responded favorably to chiropractic management, and there were no reported complications. Future investigations should establish the natural history and compare chiropractic management with other forms of treatment to gain knowledge about the effectiveness of chiropractic in managing pediatric LBP.
