The Physiotherapists Got It Wrong: Misrepresenting Chiropractic Care for Children
Originally published: 2025-01-23
The physiotherapy profession’s recent position statement on spinal manipulation and mobilization for pediatric patients is deeply flawed, biased, and lacking in comprehensive evidence. If left unchallenged, such misrepresentations not only damage public perception but also diminish the important contributions chiropractors make to children’s health and wellness.
Here’s a critical breakdown of the physiotherapists' claims—and why chiropractors must step up their game politically and scientifically.
Who They are and Their Biases
The organization behind the development of this position statement is a taskforce composed of clinician-scientists from the World Physiotherapy – International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) and the International Organisation of Physiotherapists in Paediatrics (IOPTP). Both groups are specialty divisions under World Physiotherapy, aimed at advancing evidence-based practices within their respective fields. The taskforce claims to have utilized a systematic, multi-stage process involving a literature review, a Delphi survey, and consensus workshops. However, their reliance on the National Health and Medical Research Council (NHMRC) evidence hierarchy, a framework unsuitable for evaluating nuanced clinical interventions like chiropractic care, highlights a fundamental bias. While these organizations position themselves as leaders in promoting safe and effective care, their statement reflects a narrow view that dismisses critical evidence and disregards the unique clinical expertise central to chiropractic practices. This approach undermines the diversity of methodologies and care philosophies necessary for addressing pediatric health comprehensively.
Chiropractic Adjustments Are Not Spinal Manipulation
One glaring issue is the failure to distinguish between chiropractic adjustments and the generic concept of spinal manipulation (SMT). Chiropractic adjustments are precise, scientifically informed interventions targeting vertebral subluxations. They are not the one-size-fits-all high-velocity manipulations described in the position statement. By lumping all manual therapies into one category, physiotherapists dilute the unique safety and effectiveness of chiropractic care for children.
Ignoring Best Practices from the Chiropractic Profession
The physiotherapists conveniently ignored the Foundation for Vertebral Subluxation’s Pediatric Best Practices Document, a key resource for evidence-informed chiropractic care. This document emphasizes specialized techniques tailored to the biomechanics of pediatric spines, underscoring safety and efficacy. Most importantly, the Foundation provides a clear recommendation:
RECOMMENDATION
Rating: Established
Evidence: E, L
Since vertebral subluxation may affect individuals at any age, chiropractic care may be indicated at any time after birth. As with any age group, however, care must be taken to select adjustment methods most appropriate to the patient’s stage of development and overall spinal integrity. Parental education by the chiropractor concerning the importance of evaluating children for the presence of vertebral subluxation is encouraged as are public health initiatives geared toward screening of children for vertebral subluxation beginning at birth.
This recommendation highlights the care, expertise, and responsibility chiropractors bring to pediatric care—qualities ignored in the physiotherapists’ statement. By omitting this critical evidence, they present an incomplete and biased narrative that fails to respect the chiropractic profession’s contributions.
Flawed Evidence Hierarchy and Selective Evidence Use
Physiotherapists relied on the National Health and Medical Research Council (NHMRC) evidence hierarchy, which favors randomized controlled trials (RCTs) but is ill-suited for interventions like chiropractic care. Chiropractic success often comes from clinical expertise, patient outcomes, and individualized approaches—areas this hierarchy undervalues. Worse still, they excluded key layers of evidence, including thousands of cases studies, case series and practice guidelines, thousands of positive parental testimonials from Safer Care Victoria and critical considerations like shared decision-making and family-centered care.
Chiropractic Does not Focus on Disease
The focus of the review is the treatment of various diseases and disorders through chiropractic care, which they equate with spinal manipulation (SMT). While chiropractors do perform SMT, chiropractors primarily utilize specific chiropractic adjustments to correct vertebral subluxations. Those adjustments include a host of gentle, non invasive procedures and methods designed to reduce or correct vertebral subluxations. The purpose of these adjustments are not to treat any specific disease but to enhance salutogenesis and improve the bodies ability to adapt to its environment.
Major Methodological Weaknesses
The position statement suffers from significant shortcomings. For example, it inadequately reports harms, limiting a proper benefit-harm analysis. Conditions like headaches and scoliosis were vaguely classified, undermining meaningful conclusions. And while it mentions mild adverse events, it provides no robust data on severe harms, leaving safety concerns largely speculative.
The Chiropractic Profession’s Responsibility
While the physiotherapists’ position is problematic, the chiropractic profession must also acknowledge its role in this issue. For decades, many chiropractic researchers have used terms like “spinal manipulation therapy” (SMT) to gain academic acceptance, inadvertently blurring the distinction between chiropractic adjustments and general manipulation techniques. This has fueled external misrepresentations and confusion.
Furthermore, chiropractic leadership has fallen short in key political and scientific arenas. The lack of unified action in regions like Canada and Australia allowed restrictions led by rogue regulatory boards and trade associations to go unchallenged. In the U.S., the American Chiropractic Association (ACA) has failed to defend pediatric chiropractic care effectively. The ACA president of the Council on Chiropractic Pediatrics even stated in a Washington Post interview:
"We still haven’t been able to demonstrate in the research the effectiveness that we’ve seen clinically. We can’t really say for sure what’s happening. It’s sort of like a black box. But, what we do know is that, clinically, what we’re doing is effective because we see a change in the symptoms of the child."
The focus on symptoms alone misses the broader impact of chiropractic care on overall health. To make matters worse, the ACA went on to claim:
"While treatments for children are safe and effective, more research is needed to prove they work."
This contradictory statement undermines public trust, particularly when contrasted with the ACA’s endorsements of car seats and mattresses, products it claims to evaluate rigorously. If the ACA can endorse car seats and mattresses with such certainty, why not the well-documented benefits of chiropractic care for children?
Double Standards in Healthcare
It’s worth noting that while physiotherapists and even chiropractic organizations like the ACA criticize pediatric chiropractic care, they have no problem endorsing mattresses, car seats, and massage chairs. The ACA’s willingness to promote products while failing to robustly defend pediatric chiropractic care reflects a disturbing double standard.
Call to Action for Chiropractors
This position statement serves as a wake-up call for the chiropractic profession. Chiropractors must promote accurate terminology, invest in research that includes real-world outcomes and parental testimonials, and actively engage in political advocacy to counter biased policies. Chiropractic care is about more than pain relief—it’s about optimizing nervous system function and supporting families.
Let’s take action now to debunk these myths and reclaim our role as leaders in pediatric healthcare. Chiropractors have the tools, expertise, and evidence to make a difference. The time to rise above the noise and lead is now. Together, we can correct the record and ensure a brighter, healthier future for children.
