Dr Christian Fludder

Dr Christian Fludder

Well, to start off with I’m going to open this one up and use the term manual therapist. Chiropractors, physiotherapists, and osteopaths, among others healthcare professionals utilise manual therapy as a part of a treatment process. Now this manual therapy can have a wide scope; it can be anything from a light stroking touch, to mobilisations, to manipulations. Each of these however, take into consideration several factors; the size of the child, how developed the child is, how much head control have they gained, how big is the practitioner, how compliant is the child, and of course patient preference.

This makes life very entertaining when trying to keep up with current research. A lot of studies mention manual therapy, but they do not necessarily go into detail as to what that manual therapy is. The best thing to do is to reach out and ask.

So let’s get into the crux of this one – why would a child need manual therapy? Let’s go with newborns (neonates) and infants first. Why on earth would a baby need manual therapy? What have they done so far that could have hurt themselves?

To be as delightfully blunt and graphic as possible; lemons and watermelons. If you have recently given birth, you will know precisely what I mean.

For those who are yet to enjoy this process (and I can say “enjoy” as I was the non-birthing partner in my relationship – I just got to watch the show) you will find out soon enough.

Birth itself is quite literally the most significant event that your child has ever gone through in their life. From changes of circulating hormones, to sudden muscle contractions occuring around them, and then being exposed to sudden bright lights, no longer warm and cocooned – it is a very big experience for them. And guess what? Not everything goes to plan. In recent study we had published we took a sample of parents coming through our clinic, asked them the method in which their child was born, and then assess their child. now I have to be very forthright here – this is looking at associations not causations and it is within a biased sample – but there were some very interesting associations observed.1 Of the children born naturally (vaginal) around 75% had changes to normative motion of their neck. When coming out the sunroof (C-section), this actually jumped to 85 to 90%. Include a vacuum in the process, and this jumped up again with all kids in this cohort showing signs of restricted neck motion. This became important to us as we’ve mentioned previously, restrictions in neck motion had a strong association with plagiocephaly.2

We looked at other aspects as well; were they feeding well, were they unsettled, were there difficulties with bowel movements.3 Again using a cohort of patients, we found very interesting associations. Babies who were bigger than 3.5kg were more likely to get a little bit on the stuck side – and this is because of the broadness of their shoulders – and ended up with shoulder-based issues.4 Guess what? In kids with shoulder issues, we found over 90% of them presented with unsettled behaviour as their primary complaint!

Babies can experience discomfort in a manner similar to that of adults.5 Musculoskeletal conditions can easily occur during the birthing process, and these may influence your baby’s behaviour.

But then what about the older kids, say, the school-aged ones? Well I’ll tell you two things that I see very frequently in this age range. Concerns about tone, and concerns about balance. (Academics usually comes through too but that’s usually a result of an issue with tone or balance – more about this in a later blog post!) The best way to describe tone is using a string analogy. See we understand that the brain controls the body, but it also works in the reverse with the body providing stimulation for the brain to develop and grow. (And on a side note the greatest point of stimulation from your body for your brain is the upper cervical spine – our neck!) So imagine you are holding a piece of string between your hands. I want you to pull that string tightish, so that when you move one hand, your other hand is moved as well. Guess what? that’s what good tone does – your brain says to move, and the muscle (the string) makes the bit move (the other hand). Now I want you to create slack between your hands. See how much further it takes you to move your brain hand to make your other hand move? Everything feels very loose. But what if we go the other way? It takes a lot more movement of the other hand for your brain to then sense what’s going on – this is the impact of lowered tone, it takes more action to generate the same amount of stimulation.

Now think about balance. What if your child is unable to balance properly because the brain is not getting that feedback from their legs or their feet? They would end up swaying side to side, arms flailing, and showing great difficulty in being able to do this activity. There is some wonderful research out there demonstrating that manual therapy is able to provide an increase in tone, which in turn may be able to influence balance and body awareness.6–11

So why might your child need to see a manual therapist? Primarily for concerns relating to the musculoskeletal system. But sometimes these concerns can be tricky to spot as it might show through as the unsettled baby, or the baby with a head positional preference, or the older kid with poor balance. If you are unsure, the best thing to do would be to contact your health care professional and have a chat about what’s going on. I know I’m more than comfortable in taking calls or messages from the uncertain parent, and I’m sure many others would be happy to do so as well.

 

For more information on tone or balance, feel free to have a watch of the following YouTube videos:

Can you pass a balance test for 5 year olds?

What does it mean to have low tone?

I hope you find this informative, and I’ll see you in the next blog post!

Christian Fludder

REFERENCES

  1. Fludder CJ, Keil BG. Instrument-Assisted Delivery and the Prevalence of Reduced Cervical Spine Range of Motion. Chiropractic Journal of Australia. 2018;46:162-171.
  2. Fludder CJ, Keil BG. Deformational Plagiocephaly and Reduced Cervical Range of Motion: A Pediatric Case Series in a Chiropractic Clinic. Altern Ther Health Med. 2020;(1):3-9.
  3. Fludder CJ, Keil BG. Presentation of Neonates and Infants with Spinal vs Extremity Joint Dysfunction. Chiropractic Journal of Australia. 2018;46:79-91.
  4. Keil BG, Fludder CJ. The prevalence and predisposing factors of infant glenohumeral joint dysfunction: a retrospective study of 178 cases. Chiropractic Journal of Australia. 2020;47:61-75.
  5. Goksan S, Hartley C, Emery F, et al. fMRI reveals neural activity overlap between adult and infant pain. Elife. 2015;4. doi:10.7554/eLife.06356
  6. Haavik-Taylor H, Murphy B. Cervical spine manipulation alters sensorimotor integration: A somatosensory evoked potential study. Clinical Neurophysiology. 2007;118(2):391-402. doi:10.1016/j.clinph.2006.09.014
  7. Haavik H, Murphy B. The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. Journal of Electromyography and Kinesiology. 2012;22(5):768-776. doi:10.1016/j.jelekin.2012.02.012
  8. Haavik H, Murphy B. Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense. Journal of Manipulative and Physiological Therapeutics. 2011;34(2):88-97. doi:10.1016/j.jmpt.2010.12.009
  9. Taylor HH, Murphy B. Altered Sensorimotor Integration With Cervical Spine Manipulation. Journal of Manipulative and Physiological Therapeutics. 2008;31(2):115-126. doi:10.1016/j.jmpt.2007.12.011
  10. Daligadu J, Haavik H, Yielder PC, Baarbe J, Murphy B. Alterations in cortical and cerebellar motor processing in subclinical neck pain patients following spinal manipulation. Journal of Manipulative and Physiological Therapeutics. 2013;36(8):527-537. doi:10.1016/j.jmpt.2013.08.003
  11. Haavik H, Niazi I, Jochumsen M, Sherwin D, Flavel S, Türker K. Impact of Spinal Manipulation on Cortical Drive to Upper and Lower Limb Muscles. Brain Sciences. 2016;7(12):2. doi:10.3390/brainsci7010002