A 35-year-old female presents to the office with her two children. One child is a three-month-old infant, and the other is a three-year-old toddler. The mother has been a longstanding chiropractic patient, and has recently attended a workshop where she learned that chiropractic spinal checkups for children are important. As the mother has experienced the health benefits of chiropractic first-hand, and understands the importance of preventive care, she wants to have both of her children’s spines checked. The mother informs the doctor that neither child ever complains or exhibits signs of pain or discomfort. The mother also relays that her toddler falls frequently, while playing, and that the infant needs her diaper changed many more times a day than she would expect at that age. Barring those exceptions, all seems well with both children.
Examinations of both children reveal vibrant and happy individuals upon observation. Physical examination reveals subluxations present at L5 in the infant, and L4 in the toddler – these are discovered with static palpation. These subluxation findings were exaggerated by the fact that the child would shift and squirm each time that the doctor palpated the subluxated areas. All neurological and remaining pediatric tests were unremarkable.
During the report of findings, the doctor explains the child’s assessment to the mother. The mother asks the doctor if it is OK for the children to be adjusted even though they have never complained of pain nor displayed any symptoms. The doctor reassures the mother that, just as in an adult’s case, chiropractic adjustments to the child’s subuxations are effective and necessary care for optimal health. The doctor also emphasizes the importance of adjusting the subluxations now to prevent future problems, rather than allowing the issue to persist until symptoms appear.
Has this type of situation ever happened to you? Have you ever assessed a child, found that subluxations were present, but no symptoms existed?
Would you be confident relaying to a parent that adjustments for a child are necessary when subluxations are present regardless of whether or not any symptoms are present? Would you be comfortable adjusting a child’s lumbar spine and understanding the biomechanical changes in both age groups?
In this edition of Technique Toolbox, I will address these questions that are fundamental to pediatric chiropractic care and go through a safe and effective lumbar adjustment for a pediatric patient.
BIOMECHANICS OF THE PEDIATRIC LUMBAR SPINE
Lumbar spine biomechanics are slightly different for a child in comparison to an adult because the child’s lumbar lordosis is not fully formed at this time. We must be mindful that when children are born, their thoracic kyphosis is their primary curvature. The lumbar lordosis does not fully form until the child is weight-bearing. Therefore, flexion is the primary movement in an infant, and extension of the lumbar spine is developed over time. Due to this, the primary subluxation in an infant is posteriority of the lumbar segments. Rotation is not usually involved in the subluxation until the child is weight-bearing and begins developing his or her lumbar lordosis. At this point, both posteriority and rotation play a role in the lumbar subluxation. Now that we understand the biomechanics of the pediatric lumbar spine, how do we detect and correct the problem?
|Palpation of an infants lumbar spine is displayed. Note how the patient is comfortably placed with the mother.
|Infant Lumbar Adjustment is displayed. Note how a bilateral pinky contact on the affected spinous process is taken while the patient is placed comfortably on mother’s chest.|
|Toddler Lumbar Adjustment is displayed. Note how a bilateral pinky contact on the affected spinous process is taken with the child prone on the table.
- Infant Patient: Lying prone on mother’s chest.
- Toddler Patient: Prone on table.
- Doctor: Either side of table.
- Procedure: Infant and Toddler – Use a pinky contact to palpate the posterior aspect of each spinous process of the lumbar spine to assess posteriority of the segment; Toddler – Use a pinky contact to palpate each spinous process laterally, to assess rotational deviation.
- Normal – When the infant and toddler are subluxation-free, palpation should have a soft and spongy end-feel (similar to walking on a sandy beach).
- Subluxation – When a subluxation is present in the lumbar spine, an abrupt and hard end-feel is present (similar to walking on a sandy beach, and stepping onto a sea-shell). Also, as in our sample case, the patient may squirm or become uncomfortable when palpating the affected area, further confirming the presence of subluxations.
- When this abrupt end-feel is present in an infant, this indicates that the lumbar segment has subluxated posterior. In a toddler, the subluxation is posterior, with rotation according to spinous deviation of the segment discovered through palpation.
- Patient: Infant lying prone on mother’s chest, or toddler prone on table.
- Doctor: Either side of table.
- Infant Contact: Pinky contact on the posterior spinous process of the subluxated lumbar segment.
- Toddler Contact: Pinky contact on the mamillary process, contralateral to spinous deviation of the subluxated lumbar segment.
- Stablilization: Opposite pinky stabilizing contact hand.
- LOC: P-A, using a sustained contact pressure. The sustained pressure should be no more than 4-6 ounces, maintaining the pressure in the line of correction for 20-30 seconds. There is no thrust. Simply a gentle pressure is applied as the doctor feels the vertebrae slowly glide into position.
Therefore, by taking the mamillary contact and applying P-A pressure, the posteriority is corrected – because of the P-A thrust – as is the rotation because the contact is unilateral, and on the contralateral side of spinous deviation.
Immediately following the adjustment, the abrupt end-feel should be decreased significantly, and the soft end-feel should return.
Until next time . . . adjust with confidence!