Questions raised over use of spinal manipulation
Friday June 8th, 2012
Spine manipulation for neck pain is “unnecessary and inadvisable” because it could lead to serious complications, researchers say today.
Writing in the British Medical Journal, Neil O’Connell, from the Centre for Research in Rehabilitation, Brunel University, England, say that studies “provide consistent evidence of an association between neurovascular injury and recent exposure to cervical manipulation”.
These include vertebral artery dissection – a tear to the lining of the vertebral artery, which is located in the neck and supplies blood to the brain – and stroke.
But David Cassidy, of the Dalla Lana School of Public Health, University of Toronto, Canada, argues that cervical spine manipulation is a valuable addition to patient care and should not be abandoned.
Spinal manipulation involves the application of various types of thrusts to the lumbar spine or cervical spine to reduce back pain, neck pain and other musculoskeletal conditions.
O’Connell and colleagues highlight a Cochrane review of randomised trials of neck manipulation or mobilisation, which concluded that as a stand-alone treatment, it provides only moderate short term pain relief and is unlikely to offer meaningful long term benefit.
Other trials have come to the same conclusion, they add, which means that, given the equivalence in outcome with other forms of therapy, manipulation seems to be clinically unnecessary.
“The potential for catastrophic events and the clear absence of unique benefit lead to the inevitable conclusion that manipulation of the cervical spine should be abandoned as part of conservative care for neck pain,” they conclude.
But David Cassidy and colleagues says there is high quality evidence that “clearly suggests that manipulation benefits patients with neck pain”. They also doubt that there is any direct link between manipulation and stroke.
When combined with recent randomised trial results, “this evidence supports including manipulation as a treatment option for neck pain, along with other interventions such as advice to stay active and exercise”, they write.
However, they acknowledge that, when risk, benefit, and patient preference are considered, there is “no preferred first line therapy, and no evidence that mobilisation is safer or more effective than manipulation”.
“We say no to abandoning manipulation and yes to more rigorous research on the benefits and harms of this and other common interventions for neck pain,” they conclude.
Should we abandon cervical spine manipulation for mechanical neck pain? No. Cassidy JD, Brontfort G, Hartvigsen J. British Medical Journal. BMJ 2012;344:e3680. doi=10.1136/bmj.e3680
Tags: Alternative Therapy | Pain Relief | UK News
Printer friendly pageComments
1At 08/06/2012 10:17pm Editor wrote
Some cautious language in this BMJ report. Some reports suggest it's about chiropractic. Also neurovascular injury - that's almost certainly stroke. Ed