Imagine a study evaluating the impact of spinal manipulation on tonsillitis; one that includes children and explores the possible impact on the immune system. Such a study may seem optimistic, depending on your understanding of the power of chiropractic. But not if you were an osteopath.
What They're Researching
The randomized, clinical trial I'm referring to was published just a few months ago.1 It looks at how a single "high-speed, low-amplitude technique applied to the T9-T10 vertebrae" impacts the duration and future episodes of tonsillitis in patients between the age of 3 and 65.
Versus the 40 patients in the control group (CG), the 79 patients in the "osteopathic manipulative group (OMG)" experienced significantly fewer days to resolve their current episode of tonsillitis (2.03 days vs. 2.39 days). In addition, subsequent episodes of tonsillitis in the following year were lower for the OMG (0.8/year) as compared to the CG (2.0/year). In that follow-up year, 60.8 percent in the OMG had no recurrences as compared to 22.5 percent of the CG. What makes this study of interest are the following:
- The study looks at how a single spinal manipulation can impact tonsillitis, a relatively common childhood disease normally treated with NSAIDs, antibiotics or tonsillectomy. The results have the potential to reduce the use of OTC drugs, antibiotics and surgery in children.
- The authors are not shy in explaining that "the vertebral segments T9 and T10 innervate the adrenal glands, which produce cortisol, and patients with tonsillitis have been found to have altered cortisol levels. This hormone may influence the immune response, and its levels are modified after thoracic manipulation."
But It Doesn't End There...
There seems to be a reluctance by many in our profession to be open to the reality that chiropractic does more than relieve back pain. This reluctance is not only inconsistent with my understanding of the power of chiropractic, as taught to me by my father; it is clearly not shared by researchers in the osteopathic community. Sadly, the above is not an isolated study.
"Osteopathic manipulative treatment" has also been studied as an adjunct for care of patients with pneumonia.2 The study authors note that "Osteopathic Manipulative Treatment (OMT) is a cost-effective adjunctive treatment of pneumonia that has been shown to reduce patients' length of hospital stay, duration of intravenous antibiotics, and incidence of respiratory failure or death when compared to subjects who received conventional care alone." Another paper looks at "The 2012-2013 Influenza Epidemic and the Role of Osteopathic Manipulative Medicine."3
While I haven't see it yet, I would expect to see a paper studying how OMT was shown to assist COVID patients in the near future. I'm not sure we will ever see such a paper on chiropractic (although I certainly hope we will).
The Great Irony
What makes all this ironic is the publication of two studies within the past year that examine the effectiveness of spinal manipulation by osteopaths on chronic low back pain. The first study concluded that "neither spinal manipulation nor spinal mobilization [administered by either a doctor of osteopathic medicine or physical therapist] appeared to be effective treatments for mild to moderate chronic LBP."4 In the second study, the authors noted that "standard OMT had a small effect on LBP-specific activity limitations vs sham OMT at 3 months. However, this effect was likely not clinically meaningful."5
Will We Find Ourselves Trapped in a Box of Our Own Making?
While chiropractic care is considered by many to be the undisputed leader in safe, appropriate, effective care for back pain, we seem to be less confident beyond that – at least in terms of research. I suggest, if I may be so bold, this is a great starting point given the percentage of the population that experiences back pain in a given year – but we need to substantially explore the effectiveness of chiropractic care beyond back pain, even if it is just as an adjunct to usual medical care.
As we consider our research agenda in the near term, we should be setting our sights on at least exploring tonsillitis, pneumonia and even COVID symptoms. Researchers and those who fund their studies should be looking at these opportunities carefully. If not, chiropractors could find themselves clinically trapped in a box of our own making.
References
- Luceño-Mardones A, et al. Effects of osteopathic T9-T10 vertebral manipulation in tonsillitis: a randomized clinical trial. Healthcare, 2021;9:394.
- Yao S, et al. Osteopathic manipulative treatment as a useful adjunctive tool for pneumonia. J Vis Exp, 2014;(87):50687.
- Mueller DM.The 2012-2013 influenza epidemic and the role of osteopathic manipulative medicine. J Osteopath Med, 2013;113(9):703-707.
- Thomas JS, et al. Effect of spinal manipulative and mobilization therapies in young adults with mild to moderate chronic low back pain: a randomized clinical trial. JAMA Netw Open, 2020;3(8):e2012589.
- Nguyen C, et al. Effect of osteopathic manipulative treatment vs sham treatment on activity limitations in patients with nonspecific subacute and chronic low back pain: a randomized clinical trial. JAMA Intern Med, 2021;181(5):620-630.
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