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Stop spinal manipulation for neck pain, warn researchers

8 June 2012 - 12:51pm

Spinal manipulation for neck pain should be abandoned by physiotherapists, osteopaths, and chiropractors, because it can cause stroke, academics have said in the British Medical Journal.


Debating whether cervical spine manipulation should be dropped for treating mechanical neck pain, Neil O’Connell, lecturer at Brunel University’s Centre for Research and Rehabilitation, and colleagues from the universities of Warwick and Notre Dame in Australia, argued that the technique was ‘unnecessary and inadvisable’.

And, speaking to Frontline, Mr O’Connell, a physiotherapist, said professional bodies, including the CSP, should lead the way in recommending that the technique should be abandoned.

Although more widely used by chiropractors, some physios do use spinal manipulation to treat neck pain.

BMJ paper

The BMJ paper co-authored by Mr O’Connell pointed to a Cochrane review of trials of neck manipulation, which found that as a stand-alone treatment it provided only short-term pain relief and no long-term benefit.

It also argued that research provided ‘consistent evidence’ of an association between spinal manipulation and tears to the lining of the vertebral artery in the neck, which can cause stroke.

In the BMJ ‘Head to Head’ debate, Canadian professor of epidemiology, David Cassidy, defended the use of spinal manipulation. He said that high quality evidence showed that manipulation could clearly benefit patients with neck pain; that there was no causal link between manipulation and stroke; and that the treatment should remain as an option for therapists.

Alternative treatments

Mr O’Connell said: ‘Our position is that if there is good reason to believe that there is a risk and there are alternative treatments that have the same benefit, then why use manipulation?

‘If we want to be seen as a more evidence-based profession, then we need to take account of safety issues, and it is up to professional bodies to take the lead.

‘For instance, it would be perfectly acceptable for the CSP to recommend that manipulation should not be used as a frontline treatment for neck pain.’

Professional guidelines

CSP director of professional development, Natalie Beswetherick, said the Musculoskeletal Association of Chartered Physiotherapists had produced guidelines to help physios identify patients who should not receive manipulation, and who could benefit from it.

‘Additionally, the International Federation of Orthopaedic Manipulative Physical Therapists, which includes CSP members, is drawing up a set of guidelines for assessing the risk to a patient of using the technique,’ she said.

‘The CSP has not said the technique should not be undertaken, but we have highlighted the risks of manipulating the cervical spine and will continue to raise awareness among our members on the most appropriate use of that technique.’


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