As chairperson of the special interest group in pediatrics of the European Academy of Chiropractic, Dr. Weber has worked to raise the standard of education of chiropractors in Europe treating children. Besides providing education, she published international peer- reviewed history and examination forms for the infant, child and adolescent in 2023. This is on the heels of forms she published in 2021, which have now been revised by a group of international experts to improve the forms for completeness. The goal of these new forms is to have chiropractors treating children use the same forms. This would allow us to do meaningful research as well as use the forms to guide education for manual therapy in children.

Forskning & utveckling

Pediatric manual therapy is offered in most developed countries in the world. Sweden has an ungrounded bias against manual therapy for children unlike its neighboring countries where chiropractic care for infants and children is common. All other European countries have educations that are approved by the European Council on Chiropractic Education (ECCE). This is an international autonomous organisation established by the chiropractic profession in Europe to accredit and re-accredit programmes providing first qualification chiropractic education and training. Its goal is to establish standards of excellence for the education and training of chiropractors as safe and competent primary contact practitioners.
Denmark is one of the leading countries actively researching musculoskeletal pain in children, the relationship to pain into adulthood. Other institutions both in the US and Europe are researching chiropractic care for different conditions in children. They have researched conditions that are common to different age groups and looked at the effect of chiropractic care. The results are encouraging, demonstrating that practitioners with advanced training in pediatrics improve the wellbeing of the children in a manner that is safe and effective. Another positive measure is parent satisfaction with care.

Hestbaek L, Hartvigsen J, Christensen H, Vach W. Osteopathy and chiropractic treatment in babies with infantile colic. Acta Paediatr. 2023 Oct;112(10):2239-2240. doi: 10.1111/apa.16927. Epub 2023 Aug 6. PMID: 37522528.
Wiberg KR, Wiberg JM. A retrospective study of chiropractic treatment of 276 danish infants with infantile colic. J Manipulative Physiol Ther. 2010 Sep;33(7):536-41. doi: 10.1016/j.jmpt.2010.08.004. PMID: 20937431.

Weber S. Recurrent neck pain and headaches in preadolescents associated with mechanical dysfunction of the cervical spine. .J Manipulative Physiotherapy. 2009. doi:10.1016/j.jmpt.2009.08.025
Holm LV, Vach W, Jarbøl DE, Christensen HW, Søndergaard J, Hestbæk L. Identifying potential treatment effect modifiers of the effectiveness of chiropractic care to infants with colic through prespecified secondary analyses of a randomised controlled trial. Chiropr Man Therap. 2021 Apr 19;29(1):16. doi: 10.1186/s12998-021-00373-6. PMID: 33874964; PMCID: PMC8054382.
Miller JE, Newell D, Bolton JE. Efficacy of chiropractic manual therapy on infant colic: a pragmatic single-blind, randomized controlled trial. J Manipulative Physiol Ther. 2012 Oct;35(8):600-7. doi: 10.1016/j.jmpt.2012.09.010. PMID: 23158465.
Hestbaek L, Andersen ST, Skovgaard T, Olesen LG, Elmose M, Bleses D, Andersen SC, Lauridsen HH. Influence of motor skills training on children’s development evaluated in the Motor skills in PreSchool (MiPS) study-DK: study protocol for a randomized controlled trial, nested in a cohort study. Trials. 2017 Aug 29;18(1):400. doi: 10.1186/s13063-017-2143-9. PMID: 28851412; PMCID: PMC5576290.
Fuglkjær S, Vach W, Hartvigsen J, Dissing KB, Junge T, Hestbæk L. Musculoskeletal pain distribution in 1,000 Danish schoolchildren aged 8-16 years. Chiropr Man Therap. 2020 Aug 4;28(1):45. doi: 10.1186/s12998-020-00330-9. PMID: 32746872; PMCID: PMC7401207.
Fuglkjær S, Dissing KB, Hestbæk L. Prevalence and incidence of musculoskeletal extremity complaints in children and adolescents. A systematic review. BMC Musculoskelet Disord. 2017 Oct 18;18(1):418. doi: 10.1186/s12891-017-1771-2. PMID: 29047337; PMCID: PMC5648427.
Tiwari D, Goldberg A, Yorke A, Marchetti GF, Alsalaheen B. CHARACTERIZATION OF CERVICAL SPINE IMPAIRMENTS IN CHILDREN AND ADOLESCENTS POST-CONCUSSION. Int J Sports Phys Ther. 2019 Apr;14(2):282-295. PMID: 30997280; PMCID: PMC6449018.
Lynge S, Dissing KB, Vach W, Christensen HW, Hestbaek L. Effectiveness

Pregnancy and Chiropractic Care
Pregnancy causes a temporary dynamic change in the biomechanics of the human body. Smaller problems that may have been latent may become evident and bothersome as the body changes and develops. The increasing weight of the abdomen and breasts change the curves of the back and neck. The ligamentous system is affected making joints more mobile and less stable. This combination can create problems for some women, particularly those that have had previous problems with their back or neck.
Women who have low back pain prior to pregnancy may experience greater pain during pregnancy. This complicates daily activities and increases the risk for sick leave. Pregnant women with back pain may also experience pelvic girdle pain and not uncommonly feel quite handicapped in caring for other young siblings. Adequate skills in diagnosis are critical to receiving appropriate care and guidance through pregnancy. The primary care system which is geared to save lives lacks complete training in musculoskeletal health. Chiropractors with a specialty in treating the pregnant patient are trained to examine and safely treat the pregnant patient.
The uterus is where the fetus grows and develops. It fastens with ligaments to different parts of the pelvis both in the front and in the back. The pelvis forms a ring with 3 different bones which come together acting as a support for the spine and form a unit for the hips to fasten in. Women who have back pain, groin, pelvic or leg pain can develop a temporary torque in the pelvis, affecting the lie of the uterus. When the pelvis is torqued, one or both of the round ligaments are affected causing pain and discomfort in the lower abdomen. This is commonly treated by the chiropractor specializing in the care of the pregnant patient.
Research is being done here in Sweden as well as in other countries highlighting the importance of care for this patient group by skilled practitioners to improve the quality of life during pregnancy.
Dr. Weber has published work looking at the increased risk for stoke during pregnancy and the postpartum period, and the implications for chiropractic/manual treatment of neck pain. The article emphasizes the importance of advanced educational skills for practitioner treating this patient group as well as modified treatment techniques.
Identifying the pregnant patient at high risk for stroke; recommendations for safe and effective manual therapy.
Conner SN, Trudell AS, Conner CA. Chiropractic Care for the Pregnant Body. Clin Obstet Gynecol. 2021 Sep 1;64(3):602-610. doi: 10.1097/GRF.0000000000000621. PMID: 33882524.
Oswald C, Higgins CC, Assimakopoulos D. Optimizing pain relief during pregnancy using manual therapy. Can Fam Physician. 2013 Aug;59(8):841-2. PMID: 23946024; PMCID: PMC3743693.
Bergström C, Persson M, Mogren I. Pregnancy-related low back pain and pelvic girdle pain approximately 14 months after pregnancy – pain status, self-rated health and family situation. BMC Pregnancy Childbirth. 2014 Jan 25;14:48. doi: 10.1186/1471-2393-14-48. PMID: 24460727; PMCID: PMC3937130.
Bergström C, Persson M, Mogren I. Sick leave and healthcare utilisation in women reporting pregnancy related low back pain and/or pelvic girdle pain at 14 months postpartum. Chiropr Man Therap. 2016 Feb 15;24:7. doi: 10.1186/s12998-016-0088-9. PMID: 26885363; PMCID: PMC4754933.
Bergström C, Persson M, Nergård KA, Mogren I. Prevalence and predictors of persistent pelvic girdle pain 12 years postpartum. BMC Musculoskelet Disord. 2017 Sep 16;18(1):399. doi: 10.1186/s12891-017-1760-5. PMID: 28915804; PMCID: PMC5602957.
Mühlemann D, Mühlemann MB. Rückenschmerzen in der Schwangerschaft: Diagnose, Behandlungsoptionen, Outcomes [Low Back Pain in Pregnancy: Diagnosis, Treatment Options and Outcomes]. Praxis (Bern 1994). 2015 May 20;104(11):565-74. German. doi: 10.1024/1661-8157/a002014. PMID: 26098153.
Weis CA, Pohlman K, Draper C, daSilva-Oolup S, Stuber K, Hawk C. Chiropractic Care for Adults With Pregnancy-Related Low Back, Pelvic Girdle Pain, or Combination Pain: A Systematic Review. J Manipulative Physiol Ther. 2020 Sep;43(7):714-731. doi: 10.1016/j.jmpt.2020.05.005. Epub 2020 Sep 6. PMID: 32900544.

New Guidelines for the Treatment of Low Back Pain 2017
The American College of Physicians (ACP) has presented guidelines for the treatment of low back pain based on the scientific evidence and provides clinical recommendations on noninvasive treatment of low back pain. The study has evaluated outcomes such as reduction or elimination of low back pain, improvement in back-specific and overall function, improvement in health-related quality of life, reduction in work disability, return to work, global improvement, number of back pain episodes or time between episodes, patient satisfaction, and adverse effects. The recommendations for all physicians treating patients with low back pain, whether acute or chronic conditions, was to avoid prescription of pharmacological agents and instead recommend spinal manipulation. For patients with chronic low back pain, besides spinal manipulation, other non-pharmalocgial recommendations are appropriate exercises to activate the core muscles, acupuncture, mindfulness, relaxation techniques among others. As a chiropractic physician, treatment of low back pain varies depending on the diagnosis. Critical to all patients is understanding the reason for the pain, and then learning what is neutral posture, how to activate the core to support it and then doing appropriate exercises to slowly strengthen the core with out straining it. Treatment techniques vary from deep soft tissue, gentle mobilising, activator technique (an instrument used apply a graded force to a joint, particularly when low force techniques are indicated) and manipulative joint techniques appropriate to the patients size and condition. Choose a Chiropractor whose education provides skills in diagnosis so the cause of the problem is treated and not the symptoms.


Kiropraktik är effektiv och säker vård.

Mycket forskning har gjorts omkring kiropraktik och dess effekt de senaste 20 åren och den blir starkare för varje år som går. Effectiveness of manual therapies: the UK evidence report. Forskningen har hittills främst riktat in sig på rygg- och nack relaterade problem. Resultaten visar att kiropraktik är en mycket effektiv och säker behandling för att må bra i rygg och nacke. Den behandlingsmetod som anses mest effektiv är den kiropraktiska behandlingen s.k. manipulation/mobilisering, d.v.s. justering av låsta leder (som vi kallar det i vårt dagliga arbete).
Statens beredning för medicinsk utveckling (SBU) http://www.sbu.se/, kom 2000 med en rapport som kallas ”Ont i ryggen, ont i nacken” där vi kan läsa följande om kiropraktik:
• Det finns bevis för att manipulation ger smärtlindring vid akuta och kroniska ryggbesvär.
• Det finns bevis att manipulationsbehandling av kronisk ländryggssmärta ger bättre lindring än vanligt omhändertagande av allmänläkare, sängläge, smärtstillande medicin och massage.
En europeisk kommission bestående av multidisciplinära team där bl.a. läkare, sjukgymnaster och kiropraktorer ingick, gav 2004 ut riktlinjer för effektiv och säker behandling av akuta och kroniska ländryggsmärtor. I dessa riktlinjer är manipulationsbehandling, utförd av kompetent person, en viktig del i behandlingen. Se http://www.backpaineurope.org/.

Historik

Manuell behandling är en av mänsklighetens äldsta behandlingsmetoder med rötter ända tillbaka till Hippokrates. Manuell behandling av sjukdom har förekommit i väldigt många kulturer. T.ex. Lät indianer barn gå på ryggraden på den sjuke för att förbättra läkeprocessen.
Kiropraktiken grundades år 1895 i USA av Daniel D. Palmer. Han behandlade vaktmästaren Harvey Lillard som varit döv i 17 år, efter ett fall från ett höloft. Efter kiropraktiska behandlingar återfick Lillard hörseln och folk vallfärdade till Palmer för att få behandling. Palmers teori gick kortfattat ut på att störningar i ryggraden var orsaken till alla sjukdomar, och att dessa kunde botas med manipulation av ryggraden. D.D. Palmer startade den första utbildningen för kiropraktorer och hans son B.J. Palmer tog över och utvecklade kiropraktiken.
Den moderna kiropraktiken har inte samma syn på orsaken till sjukdomar som D.D. Palmer. Kiropraktik har spritt sig över världen och finns nu i 26 länder, varav 18 i Europa. LKR, Legitimerade Kiropraktorers Riksorganisation, grundades i Sverige 1936. LKR medlemmar är nu meraen organisation som har medlemmar med olika utbildnings nivåer. Kiropraktorer med utländska utbildning är experter på funktionella störningar i rörelseorganen där hjälp till självhjälp med livsstilsfrågor är av avgörande betydelse.