Chiropractic Care in Muscular Dystrophy: Safety Considerations
Chiropractic care is not recommended for patients with muscular dystrophy due to the risk of exacerbating muscle weakness, potential for joint injury, and lack of evidence supporting its safety in this population. 1
Understanding Muscular Dystrophy and Its Management
Muscular dystrophy (MD), particularly Duchenne muscular dystrophy (DMD), is characterized by:
- Progressive muscle weakness and loss of function requiring specialized multidisciplinary care 1
- Development of joint contractures, scoliosis, and osteoporosis that necessitate careful management 2
- Respiratory complications that worsen over time, requiring specialized respiratory support 1
Risks of Chiropractic Manipulation in Muscular Dystrophy
Several factors make chiropractic manipulation potentially dangerous for patients with muscular dystrophy:
- Muscle weakness can lead to joint instability, increasing the risk of injury during manipulation 1
- Progressive scoliosis affects nearly all DMD patients after losing independent ambulation, which could be worsened by spinal manipulation 1
- Osteoporosis is common in MD patients, particularly those on corticosteroid therapy, increasing fracture risk during manipulation 2
- Respiratory compromise may be exacerbated by certain positioning required during chiropractic procedures 1
Evidence-Based Management Approaches
Instead of chiropractic care, guidelines recommend:
- Regular assessment by specialized healthcare providers including neurologists, orthopedic surgeons, and rehabilitation specialists 1
- Preventive measures to maintain muscle extensibility and minimize contractures through appropriate physical therapy 1
- Careful monitoring of respiratory function with specialized interventions as needed 1
- Appropriate exercise training under proper supervision, though evidence for specific protocols remains limited 3, 4
Respiratory Considerations
Respiratory complications are particularly concerning in muscular dystrophy:
- Patients require regular monitoring of forced vital capacity (FVC), peak cough flow (PCF), and other respiratory parameters 1
- Positioning during procedures can compromise respiratory function in patients with weakened respiratory muscles 1
- Sleep-disordered breathing is common and requires specialized management 1
Orthopedic Considerations
Orthopedic complications make chiropractic manipulation risky:
- Nearly all DMD patients develop scoliosis after losing ambulation 1
- Joint contractures develop progressively and require careful management 1
- Osteoporosis increases fracture risk, particularly in patients on corticosteroid therapy 2
Alternative Approaches for Musculoskeletal Management
Guidelines recommend these approaches instead of chiropractic care:
- Physical therapy with carefully supervised stretching and range-of-motion exercises 1
- Appropriate assistive devices and adaptive equipment 1
- Surgical interventions for contractures and scoliosis when indicated, performed by specialists familiar with MD 1, 2
- Carefully supervised exercise programs that avoid overexertion 3, 4
Special Considerations During Procedures
Any procedure requiring positioning or sedation requires:
- Careful respiratory assessment beforehand 1
- Monitoring of oxygen saturation and carbon dioxide levels 1
- Availability of appropriate respiratory support 1
- Avoidance of certain anesthetic agents that may trigger complications 1
Conclusion
The comprehensive care guidelines for muscular dystrophy emphasize specialized multidisciplinary care without mentioning chiropractic manipulation as a recommended intervention 1. Given the risks of joint injury, fracture, and respiratory compromise, along with the absence of evidence supporting its safety or efficacy, chiropractic care should be avoided in patients with muscular dystrophy.