1
Prospective, Longitudinal Outcomes Study of Pregnant Women and Children Undergoing Subluxation Based Chiropractic Care
Dr. Matthew McCoy, DC, MPH, Dr. Pamela Stone, DC, CACCP,
Christie Kwon, MS, Maggie Ashworth, BS
Report on Initial Evaluation of Project
Report Prepared by: Maggie Ashworth BS
Student Clinician 302 Augusta Dr. Marietta, GA 30067
[email protected] 434-251-8409
Advisor: Dr. Matthew McCoy
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ABSTRACT
Objective: A prospective study of subluxation based chiropractic care for pediatric and
pregnant patients of varying complaints is discussed. Patient demographic data, history,
subluxation information, quality of life survey, and outcomes were documented.
Clinical Features: Nine pediatric patients and twenty-five pregnant patients presented for care
to one chiropractic office. Pediatric patients included three female patients and six male patients
aged 6 months to 9 years old. Pediatric complaints included: right ear infection; plagiocephaly
and torticollis; reduced left neck rotation; three cases of motor vehicle accidents; sinus and
asthma complaints; two cases of low back pain; and two cases of wellness care. Pregnancy
patients age ranged from 23 to 39 and included: four complaints of sacroiliac pain; three
complaints of mid back pain; ten complaints of low back pain; one complaint of a fetus being in
the transverse presentation; two complaints of breech presentation; one complaint of frank
breech presentation; one complaint of migraine; one complaint of knee pain; two complaints of
hip pain; one complaint of asthma; one complaint of coccyx pain; one complaint of asthma; one
complaint of shoulder pain; one complaint of sciatica; two complaints of neck pain; one case of a
motor vehicle accident; and the cases of wellness or maintenance care.
Intervention and Outcome: Pediatric patients were administered adjustments consisting of
high velocity, low-amplitude full spine Diversified adjustments, while pregnancy patients were
administered Webster Technique and Diversified adjustments.
Conclusions: Chiropractic care has been shown as a safe and effective in addressing various
complaints of pediatric and pregnant patients to pediatric and pregnant patient care. Further
research in the quality of life of patients undergoing subluxation based healthcare is warranted.
Key words: Pediatric, Pregnancy, Chiropractic, Health Outcomes, Subluxation
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INTRODUCTION
Chiropractic is an alternative healthcare model to allopathic medicine. The chiropractic
model of healthcare focuses on spinal alignment and the removal of neurological interference in
the form of subluxations. Chiropractic care is the most frequently sought alternative form of
healthcare in pediatric patients.1 Lee reported that in 1997 more patients were seeking care from
complementary and alternative medicine providers than from primary healthcare providers.1 In
1997 it was extrapolated that there was roughly 30 million pediatric patient visits to chiropractors
and 60 million pediatric visits in 2007.1-3 The most common pediatric complaints for seeking
chiropractic care include: wellness or prevention; ear, nose, and throat problems; digestive
disorders; respiratory problems; musculoskeletal complaints; behavioral or neurosensory
disorders; allergies; scoliosis; injuries; and post birth checkups.2,4-5 Chiropractic care has been
documented as a safe, non-allopathic healthcare that has demonstrated a high rate of
improvement in the child’s overall presenting complaint.2
Pregnancy patients often seek chiropractic care to help with musculoskeletal complaints;
as well as, to help facilitate in the labor and delivery process.6 During pregnancy change within
the load distribution occur within the lumbar spine, sacral spine, as well as, the sacroiliac joints.
The change in the weight distribution may cause increased pressure on the spine and nerve roots,
thus causing associated pain and spinal biomechanical dysfunction.6 Increased spinal pressure
and spinal biomechanical dysfunctions may lead to increased external pressure on the developing
fetus, thus causing intrauterine constraint within the pregnancy patient. The intrauterine
constraint may hinder the normal movement of the fetus and cause a breech presentation of the
fetus.6 The breech presentation is one in which the fetus presents in a caudal presentation (feet
or buttock presenting at the birth canal) rather than the cephalic positions (head first).7
Approximately 3-5% of pregnancies result in the breech presentation.7 The utilization of
4
chiropractic care has been shown to be beneficial for pregnancy patients presenting with
musculoskeletal and breech presentation complaints.6-20
The following study documents the prospective, longitudinal chiropractic care of
pediatric and pregnant patients. The presenting study documents the progression of subluxation
based chiropractic care of the patients entering into a single office. The care was provided by
one chiropractor that specializes in pediatric and pregnancy patients. Within the study the
assessment of the vertebral subluxation, as well as the healthcare assessment outcomes of the
presenting pregnancy and pediatric patients will be analyzed and discussed.
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METHODS
The study was conducted over 9 consecutive months to analyze and collect data from two
groups: pediatric patients and pregnant patients. Participants in the study included new pediatric
and pregnant patients entering into a single private chiropractic office, as well as, existing female
patients that became pregnant during the course of their chiropractic care. Each group completed
a quality of life health survey at the onset of chiropractic care. The pregnant patients completed
a 36 item short-form health survey (SF-36). The SF-36 included a multiple item scale to assess
eight health concepts: physical functioning, role activities associated with physical activity,
bodily pain, general mental health, vitality, social functioning, role activities associated with
emotional activity, and health perceptions.21 Children aged zero to two years old completed a
pre-school children quality of life questionnaire (TAPQOL). The TAPQOL consists of 43 items
that are divided over 12 multi-item scales.22 Components of the TAPQOL assess areas of
physical, social, cognitive, and emotional domains.22 Pediatric patients aged 2-4 completed the
pediatric quality of life inventory (PedsQL). The PedsQL for children aged 2-4 covers 21 health
related quality of life domains of physical, emotional, social, and school functioning.23 The
PedsQL compromises five response alternatives of: 0= never a problem; 1=almost never;
2=sometimes a problem; 3=often a problem; 4=almost always a problem.23 Children aged five to
eighteen completed a Child Health Questionnaire (PF 28). The PF 28 survey is a 28 item
questionnaire evaluating 13 areas of a child’s well-being that include: physical functioning;
role/social physical; general health; bodily pain; parental impact in terms of time; emotional
impact; family organization; family activities; social, emotional, and behavioral; self-esteem;
mental health; global behavior; and the child’s overall health.24 The health surveys were
repeated every thirty days to analyze the progression of the patient’s care.
6
Nine pediatric patients entered into one local chiropractic office. For the pediatric
patients in the study demographic data, chief complaints, past health history, birthing history,
and presenting subluxation components were collected. Demographic data of date of birth, sex,
race, education level was taken on the pediatric patient. Past health history information included:
congenital disorders; musculoskeletal disorders; cerebrovascular problems; nervous system
complications; endocrine disorders; genitourinary complaints; digestive problems; reproductive
complaints; respiratory problems; eye, ears, or nose problems; neurological problems; trauma;
broken bones; hospitalizations; developmental milestones; immunizations; antibiotic use; and
prenatal care. Subluxation information was collected for initial exam and each consecutive 30
day re-examination. Information on subluxations included levels of spinal tenderness,
misalignments, and abnormal range of motion. Other subluxation components collected were
taken in the form of skin temperature measurements, muscle tension, and heart rate variability on
the presenting patients. Paraspinal skin temperatures were analyzed for asymmetry utilizing
thermographic readings from Insight Millenium Subluxatoin Station®. The Insight was also
utilized to record surface electromyographic (sEMG) readings to determine any muscle tension
asymmetry. Heart rate variability was recorded in the form of autonomic activity index and
autonomic balance index using Insight technology. The three variables of thermography, sEMG,
and heart rate variability were used to calculate a Neuro Spinal Functioning index (NSFi score).
Pediatric patients were delivered a full spine diversified technique adjustment. Diversified
technique is described as a high velocity, low amplitude thrust to a specific spinal or extraspinal
segment that has been identified as a segment of dysfunction.5
Twenty-five pregnant patients entered into one local chiropractic office. Information on
the pregnant patients included: demographic data, past and current history, subluxation
information, and pregnancy outcome information. Demographic data for the pregnant patient
7
included: date of birth, race, highest level of education, occupation, and marital status. History
on the pregnant patient included: chief complaint; pregnancy complications; medications during
pregnancy; musculoskeletal disorders; cerebrovascular problems; nervous system complications;
endocrine disorders; genitourinary complaints; digestive problems; reproductive complaints;
respiratory problems; eye, ears, or nose problems; neurological problems; previous number of
times pregnant; previous number of times the patient has given birth; previous c-sections and
reason for c-section; previous vaginal deliveries; adjustments prior to pregnancy; and
adjustments in the presenting office. Subluxation information included levels of spinal
tenderness, levels of misalignments, and levels of altered range of motions. Insight readings of
thermographic data, sEMG data, heart rate variability; and NSFi score were also collected for the
pregnant patients. Pregnancy outcome information collected included: how many weeks
pregnant the patient was at the start of care, how many weeks of chiropractic care the patient was
under before pregnancy, if the patient was diagnosed as infertile, if the fetus presented as breech,
how many adjustments the patient received while pregnant, whether the patient ceased care
before birth, how the baby was born, whether the labor was induced, whether an epidural or
other medication was utilized, type of provider to deliver baby, type of birth, whether the patient
was able to have a vaginal birth after a previous c-section, segments adjusted while pregnant,
other care utilized during pregnancy, and any complications experienced while undergoing
chiropractic care. Pregnant patients were delivered a full spine Diversified Technique
adjustment when needed to the cervical, thoracic, lumbar, and pelvic spinal regions. The
Webster Technique was also utilized to determine if the pregnant patients had any intrauterine
constraint and an adjustment was delivered based on the analysis. The first part of the analysis
consists of determining the presence of any posterior sacral rotation causing utero-sacral
ligament stress and sacroiliac joint subluxation.7 To determine the presence of a posterior
8
rotated sacrum the patient lies prone, while the chiropractor flexes the knees of the patient
toward the pelvis to determine the presence of any leg lag.7 The side of restricted motion
causing leg lag indicates posterior sacral rotation to the opposite side of restricted leg
movement.7 A low force adjustment was then delivered in the line of correction to the
determined posterior rotated sacral. The second part of the Webster analysis is determine the
presence of any trigger points along the round ligament that are defined as a palpable nodule
causing torque on the uterus, which leads to intrauterine constraint.7 Once any palpable nodules
were identified along the round ligament of the uterus a sustained pressure was held on each
separate trigger point for one minute, three separate times moving in a lateral to medial direction
along the round ligament.7
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RESULTS
A total of nine pediatric patients presented into a local chiropractic office. The children
ranged from the age of 6 months to 9 years old with an average age of 2.6. The pediatric patients
included three female patients and six male patients. The patients presented into the
chiropractor’s office for the following reasons: right ear infection; plagiocephaly and torticollis;
reduced left neck rotation; three cases of motor vehicle accidents; sinus and asthma complaints;
two cases of low back pain; and two cases of wellness care. Patient chiropractic visits ranged
from 1 visit to 27 visits, with an average of 7 visits. Three of the presenting patients have
dropped out of care. This is currently an ongoing study with data continually being collected.
Twenty-five pregnant patients presented to the same local chiropractic office. The age
ranges for the pregnancy patients was 23 to 39 with an average age of 30.56. Patient entered the
office with reasons that include: four complaints of sacroiliac pain; three complaints of mid
back pain; ten complaints of low back pain; one complaint of a fetus being in the transverse
presentation; two complaints of breech presentation; one complaint of frank breech presentation;
one complaint of migraine; one complaint of knee pain; two complaints of hip pain; one
complaint of asthma; one complaint of coccyx pain; one complaint of asthma; one complaint of
shoulder pain; one complaint of sciatica; two complaints of neck pain; one case of a motor
vehicle accident; and the cases of wellness or maintenance care. The presenting pregnant
patients included 8 patients that have previously been under chiropractic care in the current
office and 17 patients that have not been under care in this office. The patients in the study
consisted of 22 married women, two were single, and one patient was unspecified. Patient visits
ranged from 1 visit to 23 visits, with an average of 8.48 visits. Currently, nine patients have
dropped out of the study, one patient moved away, and eight patients have delivered their baby.
Of the deliveries, five of the patients delivered vaginally and 3 delivered via c-section. The
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reasons for deliveries via c-section included: one emergency c-section, one planned, and one
unspecified. The current study is presently ongoing with additional information to be collected
and added. Of the 4 fetal malpresentations, two of the fetuses turned to the appropriate delivery
positions, one was unable to turn, and one is unknown. The delivery for the fetal
malpresentations included one vaginal birth, one unknown, and two c-section deliveries, with
one being an emergency c-section.
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DISCUSSION
Pediatrics
Chiropractic care has been shown to be a safe complementary and alternative medicine
for children.2,25 Alcantara et al reported that based on a survey on the safety and effectiveness of
pediatric chiropractic care that chiropractors reported that 0.51% of pediatric patients or one in
1,812 patients resulted in a minor adverse event.2 Miller completed a review in 2009 detailing
the safety of manual therapy in pediatric patients.26 In the review Miller divide adverse reactions
to spinal manipulative therapy into mild, moderate, and severe.26 The review reported that in
2007 less than one percent of children experienced a mild side effect, such as irritability,
soreness, or stiffness.26 Only two moderate side effects (headache, stiff neck, and acute lumbar
pain) and four severe side effects (dysmetria, blindness, paraplegia, decrease coordination,
drowsiness, and unsteady gait) have been reported during a 59 year period with an estimate of 30
million chiropractic treatments per year.26 Alcantara et al reported that common reasons for
seeking chiropractic care include: wellness care; musculoskeletal complaints; throat problems;
neurological problems; colic; digestion/elimination problems; immune dysfunction; and trauma.2
Neurological complaints that have caused parents of pediatric patients to seek
chiropractic care include: attention deficit disorder, developmental delay syndromes, motor tics,
seizures, and autistic behaviors.27-33 Improvements in attention, behavior, and focus with a
decrease in hyperactivity have been noted in two separate case studies of a 3 year old male and a
10 year old male while receiving chiropractic care, nutritional advice, and proprioceptive
exercises.27,28 Brown reported that chiropractic care can be a complementary approach to
children suffering from seizures.33
Alcantara et al discussed a case study of a six year old with a medical diagnosis of
transient motor tic disorder. The patient presented with bilateral eye blinking and eye rolling in
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multiple directions before the onset of chiropractic care. The patient’s history revealed a
previous fall from her bicycle and a fall from her bed one week prior to the onset of involuntary
eye movements. The patient received Toggle adjustments to the cervical spine and Gonstead
Technique to the pelvis for 6 visits with a resulting resolution of the motor tic disorder.30 The
patient began experiencing complaints of eye blinking and involuntary movement 2 ½ months
later following an ice-skating fall. The patient was managed with the same protocol with
resolution of the complaints.30
Developmental assessment is an important component of the pediatric patient
examination. Components of the developmental assessment of the pediatric patient consists of
measuring weight, height, milestones, social development, motor development, emotional
development, sensory processing, and language.33
A case report documents a 2 year old fraternal twin female delivered by c-section due to
breech presentation. The patient presented with plagiocephaly, frequent rages, furious temper,
tantrums, nightmares, and slower intellectual and emotional development than her twin brother
that was born vaginally. The child was treated with chiropractic care and a multi-mineral
supplementation. After her 1st adjustment the patient had leveling of the head, shoulder and
pelvis. The patient began experiencing stability within her family and pre-school environment
and stopped walking on her toes after her 5th adjustment. The patient continued yearly follow-
ups and is now 7 years old and at the same developmental stage as her twin brother.29
Lerner completed a case study on a 4 year old male that had a history of learning
disorder and speech delay. The patient was seen for 44 visits utilizing Pettibon and Diversified
chiropractic adjustments. Following chiropractic care there was noted improvement in clarity of
speech, comprehension of verbal directions, improvement of emotional development and
behavior, and improvement in child’s attention.32 A case of a 30 month old, diagnosed to be
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within the Autistic spectrum, received full spine and cranial adjustments and demonstrated
improvements in social behavior and receptive language abilities after one month of care.31
Chiropractic care for gastrointestinal issues had been documented in cases of colic, acid
reflux, and constipation.35-42 Infantile colic affects 20% to 39% of infants within the first three
weeks after birth to the 3rd or 4th month of life.40 Six cases of 12 patients have demonstrated the
resolution of infantile colic following chiropractic care.35-40 A retrospective study of 16 infants
demonstrated a causal link between birth trauma-induced upper cervical injury and the onset of
acid reflux and colic. The retrospective study demonstrated a resolution of nine cases of acid
reflux and seven cases of infant colic following upper cervical chiropractic care.36
Approximately 3% of pediatric outpatient visits and 25% of pediatric gastrointestinal
visits are related to complaints associated with defecation.41 As suggested by the current
chiropractic literature, symptoms of pediatric constipation may be successful managed utilizing
chiropractic care.42 Two case studies have demonstrated resolution of constipation and
gastrointestinal complaints following chiropractic care.37,40
Nocturnal enuresis currently affects approximately 10-20.4% of children up to 7 years
old.43 The occurrence of bedwetting for males is 15-22% and 7-15% for females at age 7 years
old with a reduction to 1-2% during teenage years.43 Two case reports of a 9 year old boy and an
11 year old boy demonstrated a reduction in nocturnal enuresis following high velocity, low-
amplitude adjustments.43-44
Ear, nose, throat, sinus, allergy, and asthma complaints commonly affect children. Otitis
media accounts for over 35% of all pediatric visits in the United States and is the second most
common diagnosed childhood infection, after the common cold.45,46 Fallon completed a case
series of 332 children that had been diagnosed with otitis media at ages 27 days to 5 years and
found that there is a strong correlation between chiropractic adjustments and the resolution of
14
otitis media.46 Fedorchuk reported a case study on a 8 year old female that experienced a
decrease in chronic otitis media, neck pain, headaches, and sinus infections following mirror
image adjustments, exercises, and traction to the cervical spine.45 Alcantara et al completed a
case study on a 7 year old male who suffered from asthma, allergies, and chronic colds.47
Following subluxation based care including specific low-force adjustments utilizing Activator
care the patient was able to discontinue allergy and asthma medications and the use of his
nebulizer.47 A case study documented a 17 month old female that presented with glaucoma due
top increase in intraocular pressure since birth.48 The patient had underwent 13 eye surgeries
before the age of 15 months and had an increase susceptibility to sinus infections.48 The patient
experienced a reduction in sinus infections and the restoration of normal intraocular pressure
following Activator and Craniosacral adjustments.48 An 11 year old patient presented for
chiropractic care following complaints of chronic sinus infection and a loss of olfaction that was
restored following three months of chiropractic care.49
Alcantara et al reported out of 577 surveyed patient reports that 26% of the patient
complaints were musculoskeletal related.2 Torticollis is a musculoskeletal condition that is
defined as a unilateral contracture of the sternocleidomastoid muscle (SCM).50 Torticollis can
affect infants for a variety of reasons that may include stretching of the SCM during delivery that
can result in a pseudotumor, subluxation of the upper cervical vertebra from fetal positioning, or
a difficult delivery.50 Pseudotumor and upper cervical subluxation represent the most common
etiologies of neonatal torticollis.50 Fetal malpositions such as posterior or breech presentation
account for a large amount of torticollis in neonates.50 The atlanto-axial motor unit has been
identified as the most common area of subluxation in congenital torticollis.50 Subluxations of the
lower cervical and thoracic spine has also been identified in the etiology of cases of torticollis.50
A case study presented a 10 year old boy with complaints of acute onset of torticollis, neck pain
15
and subluxation that was managed with Torque Release Technique, Activator Methods,
interferential and moist heat to the cervical and thoracic spine.3 The patient was pain free, had
improved posture, and an increase in range of motion following 12 chiropractic visits.3
Cervical dysfunction has been a proposed cause of migraine. It has been proposed that
upper cervical dysfunction can lead to pressure on the trigeminal afferent nerve, which can cause
the perception of pain associated with migraines. In a case of a 12 year old boy with complaints
of neck pain, migraine, and associated vertigo the patient was able to experience a cessation of
symptoms following chiropractic care.51
Recent studies have estimated the prevalence of low back pain in children to be
approximately 50% with roughly 15% experiencing frequent or constant pain. Fifty-four
children presented with complaints of low back pain and were treated with chiropractic care.
The results of the chiropractic care were favorable in reduction of pain with no reported
complications.52
The following study presented pediatric patients entering into a local chiropractic office
with complaints of ear pain, torticollis, neck pain, asthma, allergies, and low back pain.
Reduction in subluxation findings has been shown to assist in the resolution of such symptoms.
Based on the previous discussed literature chiropractic care has been shown favorable in cases of
these complaints.
Pregnancy
It has been reported by the National Board of Chiropractic Examiners that chiropractors
co-manage 72.1% of pregnant patients.53 A chiropractic survey by Stuber identified that of
surveyed chiropractors 94% felt that spinal manipulative therapy is a appropriate treatment for
pregnant patients experiencing low back pain, mid-back pain, neck pain, and headache.54 Stuber
documented the percentage of chiropractors that would manage pregnant patients with the
16
following co-morbidities: multiple pregnancy (83%), gestational diabetes (56%), hypertension
(39%), pre-eclampsia (22%), ectopic pregnancy (11%), blood disorders (11%), and excessive,
unexplained spotting (0%).54 Ninety-four percent of surveyed chiropractors indicated that
chiropractic care for pregnancy patients is somewhat safe and two-thirds of those surveyed
indicated that spinal manipulative therapy was extremely safe for the pregnant patient.54 The
safety of chiropractic in pregnant patients is shown in a case series of 17 patients receiving
chiropractic care.17 In the case series 16 of the17 patients experienced clinical improvement
after an average of 4.5 chiropractic visits with no adverse effects reported to care.17 Chiropractic
care has also been shown as a safe and effective treatment for pregnancy patients suffering from
headaches.19 For the pregnancy patient certain circumstances indicate a contraindication for
chiropractic care and warrant a referral. Contraindications for chiropractic care include, but not
limited to: vaginal bleeding, ruptured amniotic membrane, cramping, sudden onset of pelvic
pain, premature labor, placenta previa, placenta abruption, ectopic pregnancy, and moderate to
severe toxemia.6
Approximately 48% to 56% of pregnant patients experience pregnancy related
lumbopelvic pain.10 It has been stated that women who experience pregnancy related
lumbopelvic pain during pregnancy are more likely to experience pain in that region during
delivery.10 It has been reported that 72% of pregnant patients experiencing low back pain would
likely benefit from chiropractic care.6 Four case studies of presenting pregnancy patients
experiencing low back pain was effectively reduced utilizing chiropractic care.8,9,11,13 In one of
the previous case studies a radiating component into bilateral hips and the right leg was also
relieved following Cox flexion and distraction technique.8
A prospective study on pregnancy related lumbopelvic pain documents the care of 115
patients. The study depicts that 57% of the 115 patients experienced an excellent or good
17
improvement, 51% experienced clinically significant improvements in disability, and 67% of
patients experienced a clinically significant improvement in pain after the onset of care. The
study completed follow-up data on 61 patients for an average of 11 months. The follow-up data
revealed that 85.5% of the patients rated their improvement as excellent or good, 73% reported a
clinically significant improvement in disability, and 82% experienced a clinically significant
improvement in pain.10
Borggren states that pregnancy patients seek chiropractic care “to assure the patient a
comfortable pregnancy and to aid in an uncomplicated labor and delivery”.6 A case study details
chiropractic care during the delivery of a baby girl in a 26 year old nulliparious female.12 After
23 hours of labor the patient was only 7 cm dilated with significantly diminished frequency and
duration of contractions and a noted decrease fetal heart tone.12 Chiropractic care was utilized at
this time via the Webster Technique to patient’s left posterior rotated sacrum and the pregnancy
psoas release technique to the right psoas.12 Following the chiropractic care the attending
midwife reported improvement in labor progression.12 At 34 hours of labor the chiropractor
performed the psoas release technique again, half an hour later the patient was in full cervical
dilation, and at 35 hours the baby was born.12
Increased external force that obstructs fetal movement can result in intrauterine
constraint.6 Intrauterine constraint has been related to increased incidents of fetal malpositions,
such as a transverse (perpendicular position) or breech presentation (buttock or foot presentation)
of the fetus, and structural defects to the peripheral and craniofacial skeleton.6,15 The occurrence
of perinatal mortality is four times higher in a breech presentation than in a normal vertex
position.15 Malposition of the fetus, such as a breech presentation, can hinder a vaginal birth,
thus necessitating a c-section. Approximately 13% of performed c-sections are due to breech
presentation.15
18
The Webster Technique has been shown to balance the pelvis and the corresponding
muscles and ligaments to alleviate intrauterine constraint.6 The reduction of intrauterine
constraint allows for decrease pressure on the uterus to enhance a favorable environment for the
fetus to assume the appropriate position.6 A survey administered to chiropractors involved in the
International Chiropractic Pediatric Association indicated that 82% utilize the Webster
Technique with a 92% success rate in alleviating intrauterine constraint.15 Five reporting studies
discuss the alleviation of intrauterine constraint and successful transitions of the fetus to the
vertex positions in twelve pregnancy cases utilizing Webster Technique.7,14,16,18,20 In one of the
five reporting studies the Webster Technique was utilized with the Activator Adjusting
Instrument to reduce the sacral subluxation to allow for a decrease in intrauterine constraint.18
The following survey documented 25 pregnancy patients that entered into one
chiropractic office with complaints of fetal malposition and musculoskeletal complaints.
Chiropractic care has been documented as a successful management in cases of breech
presentation and musculoskeletal complaints such as low back pain and headaches as a result of
removal of subluxations presenting in a patient. 6-20
19
CONCLUSION
A safe and effective alternative healthcare for pediatric patients has been shown to be
chiropractic care. Following correction of subluxations, through chiropractic care, patients
reported improved symptomatology associated with: musculoskeletal problems; ear, nose, and
throat problems; neurological complications; gastrointestinal complaints; and genitourinary
problems following the removal of neurological interference due to spinal biomechanical
alteration. Symptoms associated with musculoskeletal complaints and fetal malposition has been
shown to reduce following subluxation based chiropractic care. Quality of life measurements
were taken and analyzed based on the progression of subluxation based care. Due to the limited
amount of research on pediatric and pregnant patients and those patient’s quality of life
measurements further research in this area is warranted.
20
ACKNOWLEDGEMENTS
The author of this paper would like to thank Dr. Matthew McCoy for the guidance and
opportunity to participate in this study. Special thanks is also given to Dr. Pamela Stone for
providing the subluxation based chiropractic care and to Christie Kwon for direction and support
during the duration of this study.
21
REFERENCES
1. Lee AC, Li DH, Kemper K. Chiropractic care for children. Arch Pediatr Adolesc. 2000
Apr;154:401-407.
2. Alcantara J, Ohm J, Kunz D. The safety and effectiveness of pediatric chiropractic: a
survey of chiropractors and parents in a practice-based research network. Explore. 2009;
5(5):290-295.
3. Alcantara J, Fleuchaus S, Oman R. Resolution of torticollis, neck pain, and vertebral
subluxation in a pediatric patient undergoing chiropractic care. J Pediatr Matern & Fam
Health. 2009 Fall;4:1-9.
4. Spigelblatt L, Laîné-Ammara G, Pless IB, Guyver A. The use of alternative medicine by
children. Pediatrics. 1994 Dec;94(6):811-814.
5. Alcantara J, Ohm J, Kunz D. The chiropractic care of children. J Altern Complem Med.
2010 Nov 6;16(6):621-626.
6. Borggren C. Pregnancy and chiropractic: a narrative review of the literature. J Chiropr
Educ. 2007;6:70-74.
7. Thomas JC. The Webster Technique in a 28 year old woman with breech presentation &
subluxation. J Vert Sublux Res. 2008 Apr 7;1-3.
8. Kruse RA, Gudavalli S, Cambron JC. Chiropractic treatment of a pregnant patient with
lumbar radiculopathy. J Chiropr Educ. 2007;6:153-158.
9. Hwang K. Chiropractic care helps patient with pregnancy-related posterior pelvic pain. J
Clin Chiropr Pediatr. 2009 Jun;10(1):603-606.
10. Murphy DR, Hurwitz EL, McGovern EE. Outcome of pregnancy-related lumbopelvic
pain treated according to a diagnosis-based decision rule: a prospective observational
cohort study. J Manipulative Physiol Ther. 2009 Oct;32(8):616-24.
22
11. Stuber KJ, Smith DL. Chiropractic treatment of pregnancy-related low back pain: a
systematic review of the evidence. J Manipulative Physiol Ther. 2008 Jul-Aug; 31(6):
447-454.
12. Alcantara J, Ohm J, Ohm J. Chiropractic care of a patient with dystocia and pelvic
subluxation. J Pediatr Matern & Fam Health. 2009 Win;1:1-5.
13. Alcantara J, Hamel I. The chiropractic care of a gravid patient with a history of multiple
caesarean births & sacral subluxation. J Vert Sublux Res. 2008 Mar:1-5.
14. Drobbin D, Welsh C. Chiropractic care of a pregnant patient presenting with intrauterine
constraint using the Webster in-utero constraint technique: a retrospective case study. J
Pediatr Matern & Fam Health. 2009 Spr;2:1-3.
15. Pistolese RA. The Webster Technique: a chiropractic technique with obstetric
implications. J Manipulative Physiol Ther 2002 Jul-Aug;25(6):E1-9.
16. Stone-McCoy P, Sliwka M. Resolution of breech presentation confirmed by ultrasound
following the introduction of Webster technique: a case study & selective review of the
literature. J Pediatr Matern & Fam Health. 2010 Win;1:11-17.
17. Lisi A. Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective
case series. J Midwifery Womens Health. 2006 Jan-Feb;51(1):e7-10.
18. Rubin D. Resolution of breech presentation using an Activator adjusting instrument to
administer Webster’s technique in three women undergoing chiropractic care. J Pediatr
Matern & Fam Health. 2010 Win;1:18-21.
19. Alcantara J, M Cossette. Intractable migraine headaches during pregnancy under
chiropractic care. Complement Ther Clin Pract. 2009 Nov;15(4):192-7.
20. Kunau PL. Application of the Webster in-utero constraint technique: a case series. J Clin
Chiropr Pediatr. 1998;3(1):211-216.
23
21. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). Med
Car. 1992 Jun;30(6):473-483.
22. Raat H, Landgraf J, Oostenbring R, Moll H, Essink-Bot ML. Reliability and validity of
the infant and toddler quality of life questionnaire (ITQOL) in a general population and
respiratory disease sample. Qual Life Res. 2007;16:445-460.
23. Petersen S, Hägglöf B, Stenlund B, Bergström E. Psychometric properties of the swedish
PedsQL, pediatric quality of life inventory 4.0 generic core scales. Acta Paediatr.
2009;98:1504-1512.
24. Georgalas C, Babar-Craig H, Arora A, Narula A. Health outcome measurements in
children with sleep disordered breathing. Clin Otolaryngol. 2007;32:268-274.
25. Alcantara J. A critical appraisal of the systematic review on adverse events associated
with pediatric spinal manipulative therapy: a chiropractic perspective. J Pediatr Matern &
Fam Health. 2010 Win;1:22-29.
26. Miller JE. Safety of chiropractic manual therapy for children: how are we doing? J Clin
Chiropr Pediatr. 2009 Dec;10(2):655-660.
27. Wittman R, Vallone S, Williams K. Chiropractic management of six-year-old child with
attention deficit hyperactivity disorder (ADHD). J Clin Chiropr Pediatr. 2009 Jun;10:612-
620.
28. Stone-McCoy P, Przybysz L. Chiropractic management of a child with attention deficit
hyperactivity disorder & vertebral subluxation: a case study. J Pediatr Matern & Fam
Health. 2009 Win;1:1-8.
29. Blum CL, Cuthbert S. Development delay syndromes and chiropractic: a case report. J
Pediatr Matern & Fam Health. 2009 Sum;3:1-4.
24
30. Alcantara J, Davis Alisha, Oman RE. The effects of chiropractic on a child with transient
motor tics using gonstead & toggle techniques. J Pediatr Matern & Fam Health. 2009 Spr
;2:1-9.
31. Fox M. Changes to autistic behaviors following chiropractic care in a 30-month-old. J
Clin Chiropr Pediatr. 2006;7(1):461-468.
32. Lerner B, Lerner S. Improvement in learning and speech disorder in a child with vertebral
subluxations undergoing chiropractic care. J Pediatr Matern & Fam Health. 2009
Fall;4:1-7.
33. Brown N. The use of chiropractic adjustments as a complementary approach to treatment
of seizures in children. J Clin Chiropr Pediatr. 2005;6(3):436-437.
34. Fallon JM. Developmental-behavioral pediatrics: the chiropractor’s role. J Clin Chiropr
Pediatr. 1997;2(1):122-125.
35. Killinger LZ, Azad A. Chiropractic care of infantile colic: a case study. J Clin Chiropr
Pediatr. 1998;3(1):203-206.
36. Elster E. Sixteen infants with acid reflux and colic undergoing upper cervical chiropractic
care to correct vertebral subluxation: a retrospective analysis of outcome. J Pediatr
Matern & Fam Health. 2009 Spr;2:1-7.
37. Batte S. Resolution of colic, constipation, and sleep disturbance in an infant following
chiropractic care to reduce vertebral subluxation. J Pediatr Matern & Fam Health. 2010
Win;1:1- 5.
38. Van Loon M. Colic with projectile vomiting: a case study. J Clin Chiropr
Pediatr.1998;3(1):207-210.
39. Cuhel JM, Powell M. Chiropractic management of an infant patient experiencing colic
and difficulty breastfeeding: a case report. J Clin Chiropr Pediatr. 1997;2(2):150-153.
25
40. Sheader WE. Chiropractic management of an infant experiencing breastfeeding
difficulties and colic: a case study. J Clin Chiropr Pediatr. 1999;4(1):245-247.
41. Horkey M. Resolution of chronic constipation and neck pain following chiropractic care
in a 6-year-old female. J Pediatr Matern & Fam Health. 2010 Spr;2:51-55.
42. Holbrook B. Chiropractic treatment of childhood constipation: a review of the literature. J
Clin Chiropr Pediatr. 2005;6(3):427-431.
43. Rodnick A, Rodnick P. Resolution of childhood nocturnal enuresis following
subluxation-based chiropractic care: a retrospective case report. J Pediatr Matern & Fam
Health. 2010 Fall;4:159-162.
44. Alcantara J, Weisberg JE. Resolution of nocturnal enuresis and vertebral subluxation in a
pediatric patient undergoing chiropractic care: a case report & review of the literature. J
Pediatr Matern & Fam Health. 2010 Fall;4:143-149.
45. Fedorchuk C, Cohen A. Resolution of chronic otitis media, neck pain, headaches & sinus
infection in a child following an increase in cervical curvature & reduction of vertebral
subluxation. J Pediatr Matern & Fam Health. 2009 Spr;2:1-8.
46. Fallon JM. The role of the chiropractic adjustment in the care and treatment of 332
children with otitis media. J Clin Chiropr Pediatr. 1997;2(2):167-183.
47. Alcantara J, Van Roo L, Oman RE. Chiropractic care of a pediatric patient with asthma,
allergies, chronic colds & vertebral subluxation. J Pediatr Matern & Fam Health. 2009
Sum;3:1-7.
48. Conway CM. Chiropractic care of a pediatric glaucoma patient: a case study. J Clin
Chiropr Pediatr. 1997;2(2):155-156.
26
49. Heagy DT, Canty A. Restoration of olfaction in a child with chronic sinusitis undergoing
subluxation-based chiropractic care: a case report. J Pediatr Matern & Fam Health. 2009
Sum;3:1-4.
50. Fallon JM, FYSH PN. Chiropractic care of the newborn with congenital torticollis. J Clin
Chiropr Pediatr. 1997;2(1):116-121.
51. Kelly DD, Holt K. Resolution of vertigo, migraines and neck pain in a 12 year old boy
receiving chiropractic care- a case study. J Pediatr Matern & Fam Health. 2010
Fall;4:150-153.
52. Hayden JA, Mior SA, Verhoef MJ. Evaluation of chiropractic management of pediatric
patients with low back pain: a prospective cohort study. J Manipulative Physiol Ther.
2003 Jan;26(1):1-8.
53. National Board of Chiropractic Examiners Practice Analysis of Chiropractic 2010.
Chapter 8.
54. Stuber Kent. The safety of chiropractic during pregnancy: a pilot e-mail survey of
chiropractics’ opinion. Clin Chiropr. 2007;10:24-35.