We are writing this letter in response to your editorial article Olson KA, Clewley D, Milne, N et al. (2024): Spinal manipulation and mobilisation for pediatric conditions: time to stop the madness; JMMT Vol. 32 Nr.3, 207–210
Manual Medicine in children has been well established for decades in modern medicine. It is always necesssary to engage in professional debate on the base of profound scientific findings. Polemics based on inadequate research will get us nowhere. Defamatory word games damage the debate and discredit your own scientific and professional reputation.
The international taskforce [1] who drew up the blatantly unscientific conclusion referring to ‘madness’ when it comes to spinal manipulation/mobilization in children fails to take into account the work of many other international Manual Medicine expert groups who share at least the similar expertise in the treatment of infants and babies:
In 2013, a German taskforce [2] including professionals from different leading Manual Medicine schools gave recommendations for diagnostics and treatment in children affected.
As expert clinicians working with Manual Medicine techniques on babies and children we know via our daily hands-on work and recent valid research [3]: spinal mobilisation/manipulation is safe, not harmful and can be a more than necessary tool to treat infants in the very best way in order to help them with different conditions (e.g. dysfunctions at the cervicooccipital junction).
The Dutch Manual expert colleagues [4] make accessible for everyone their total number of treated babies on an annual basis for decades – simultaneously showing the nonexistence of severe adverse effects (10).
Recently, a German Manual Medicine expert task force with decades of clinical experience in the Manual Medical therapy published a Level II-a and a Level I-b study on Manual Medicine techniques of the baby cervical spine in 2021/2022, which demonstrated the effectiveness of manipulation [5, 6]
Unfortunately, this evidence is not cited in the publications of your task force – you did not provide complete scientific literature research. The task force’s authors’ ignorance versus the carefully constructed multicentre study of Sacher et al. speaks a language full of bias. It is also necessary and relevant to take into account valid ‘old’ data and publications in order to achieve a complete picture before drawing conclusions to shut valid techniques down as ‘mad’ (e.g [7–9].
Your argumentation that the spinal treatment of dysfunction might delay further diagnostic necessities in babies with possible underlying other medical conditions can only be understood by taking into account that you are writing from a physiotherapist’s point – i.e. not a physician‘s point of view. As trained physicians, this is always the first and most relevant fact: primum non nocere – it is needless to say how profoundly babies are examined prior to working on them.
We need to stress that not treating these babies with spinal techniques would mean that we actively derive these patients from a treatment that has proven its effectiveness in the hands of the experienced [3,10].
The true fact that there exists a paucity of large clinically well-designed studies does in no way justify the conclusion that the spinal techniques successfully implemented over the last 50+ years by experts exclusively (or predominantly) treating babies and children do no longer have a right to exist.
Spinal techniques in the infant patient population have absolutely nothing to do with madness. Their use must not be stopped.
Biographies
Bettina Küsgen Specialist Doctor in Orthopaedic Surgery and Manual Medicine (MWE) – maintaining a private practice specialized in Manual Medicine for children and adults in Cologne, Germany: Praxis für Orthopädie und Manuelle Medizin, Huhnsgasse 34, D-50676 Köln. She was trained by and worked alongside Dr Heiner Biedermann for 14 years in their practice
Michael Ammermann, Specialist Doctor in Orthopaedic Surgery and Manual Medicine (MWE) - maintaining a private practice specialized in Manual Medicine for children and adults in Düsseldorf, Germany: Privatpraxis Ammermann, Kaiser-Wilhelm-Ring 1, D-40545 Düsseldorf. He was trained by and worked alongside Dr Heiner Biedermann
Disclosure statement
No potential conflict of interest was reported by the author(s).
References
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