Chiropractic Manipulation for Childhood Asthma
The New England Journal of Medicine -- February 4, 1999 -- Volume 340,
To the Editor:
The conclusion reached by Balon et al. is based on
the finding that there was no significant difference between low-velocity,
high-amplitude chiropractic manipulation and a "simulated" chiropractic
treatment involving low-velocity, low-amplitude manipulation. Regarding
the rationale for this simulated treatment, the authors state, "We
are unaware of published evidence that suggests that positioning, palpation,
gentle soft-tissue therapy, or impulses to the musculature adjacent to
the spine influence the course of asthma." Although this may be true of
the chiropractic literature, the manipulations used for the simulated treatment
are those typical of osteopathic manipulative therapy, and there is substantial
research on the effect of these types of manipulations on physiologic functioning,
including respiration. Examples include the report by Howell et al. (1)
on osteopathic systemic therapy for chronic obstructive lung disease and
the report by Purdy et al. (2) on the systemic effects of manipulation
of the neck. Kuchera and Kuchera (3) and Stanton and Mein (4) provide detailed
discussions of techniques and mechanisms.
Balon et al. found that both forms of treatment resulted
in improvement in symptoms, decreased use of medication, and improvement
in the quality of life. Although the relevant statistical data are not
provided, an examination of the reported data suggests that these improvements
were likely to have been significantly different from the base-line findings
in both groups.
Thus, the most that can be concluded from the study
is that chiropractic spinal treatment is not significantly better
than a rather crude form of osteopathic soft-tissue treatment. Concluding,
as the authors do, that the improvement in both groups was simply due to
a placebo effect is not justified, since the physiologic effects of manipulations
similar to the simulated treatment are well documented.
Douglas G. Richards, Ph.D.
Eric A. Mein, M.D.
Carl D. Nelson, D.C.
Virginia Beach, VA 23454
1. Howell RK, Allen TW, Kappler RE. The influence of osteopathic manipulative
therapy in the management of patients with chronic obstructive lung disease.
J Am Osteopath Assoc 1975;74:757-60.
2. Purdy WR, Frank JJ, Oliver B. Suboccipital dermatomyotomic stimulation
and digital blood flow. J Am Osteopath Assoc 1996;96:285-9.
3. Kuchera M, Kuchera WA. Osteopathic considerations in systemic dysfunction.
Kirksville, Mo.: KCOM Press, 1991.
4. Stanton DF, Mein EA, eds. Manual medicine. Phys Med Rehabil Clin
North Am 1996;7.