We love it when ordinary medical research backs what we’ve been saying for a long time. Chiropractors have long been caring for infants, using gentle and careful techniques, to support infants as they develop. Postural asymmetries are one major issue, seen when babies favour one side when they sleep or feed. This can often lead to plagiocephaly (or an asymmetrical flat spot on the back of the head) and other complications. A recent study has supported the hypothesis that even a single manual intervention has a short-term positive effect on postural and movement asymmetries in 14-24 week old infants.
While the study wasn’t chiropractic-specific, it looked at the range of therapies widely classed as ‘manual medicine’ modalities. Chiropractic belongs to this class of interventions, even though we don’t use the term ‘medicine.’
Positional abnormalities aren’t uncommon in infants. It is quite common to see cervical (neck) mobility restrictions, which often co-occur with torticollis (wry neck), plagiocephaly or a c-shaped position when lying flat. Infants with these challenges may find it difficult to turn their heads to both sides when feeding, often leading to difficulties in breastfeeding.
The findings of the study won’t be a surprise to chiropractors, as there are a plethora of case studies and likely a mountain of clinical anecdotes in which positional asymmetries have responded incredibly well to chiropractic care. What is interesting in this study is the preamble: there is now a recognition that “infants with pronounced positional plagiocephaly and/or brachycephaly (PPB – or a wide-shaped head due to a large flat spot at the back)) show increased developmental delays later on.” [1] The study went on to confirm that, in children under three years of age, motor skills are particularly affected, followed by cognitive and language deficits in toddlers.
This is concerning as neuromotor deficits can create other problems later on – both in terms of physical and brain development. Thus, the rationale for acting early in supporting movement is increasingly present.
The present study didn’t just look at manual therapies (as delivered by paediatricians, physiotherapists or osteopaths), but it delivered its own dataset. It was a controlled trial in which two parallel groups were studied. All infants who took part in the study were aged between 14 and 24 weeks (corrected for gestational age). They either had stereotypical posture or movement asymmetries, and the treatment group had to have reversible functional abnormalities or segmental disorders. They could not have undergone manual therapeutic intervention in the four weeks prior to treatment.
The protocol was simple: the infants were assessed, the intervention group was then cared for by a paediatric physician with several years experience in paediatric neurology, and then the parents were given an exercise program to follow up with at home. This exercise program went for 4-6 weeks, whereas the infant only receive one manual intervention.
Both the intervention group and the control group did the exercise program, and both groups improved significantly over the course of of the study. However, the intervention group improvement was higher than the control group – to a level that researchers defined as ‘statistically significant.’
This led to a research conclusion that “the single manual medicine treatment of children with movement asymmetries significantly improves the degrees of asymmetry in children aged 14-24 weeks in a 4-6 week follow-up.” [1]
It is a simple study with a simple result. But the results could be far reaching as parents and clinicians alike work to support the neurodevelopent of children. As chiropractors have been saying for a long time – this care should start at birth, as those burgeoning brains and nervous systems adapt to the world they are growing up in. We can’t wait to see what else emerges in chiropractic paediatric research. There is a world of promise and a world of work yet to be done.
Reference:
Sacher, R., Knudler, M., Wuttkek, M., Wustkamp, N., Derlien, S., Loudovici-Krug, D (2021). Manual therapy of infants with postural and movement asymmetries and positional preference. Manuelle Medizin. https://doi.org/10.1007/s00337-020-00760-9
