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Bill Egan -> Re: Petition to stop neck manipulation (August 21, 2005 5:52:00 AM)
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Currently there is no evidence that shows cervical manipulation is superior to mobilization. The risk for serious adverse events following cervical manipulation is exteremely low. However, a recent study showed increased odds of temporary side effects following cervical manipulation compared to mobilization. See below. I agree with others that a sensible position is to attempt to treat first with mobilzation, muscle energy, or other procedures. At the same time, we should not abandon the practice of cervical manipulation, nor make it illegal, except for barbers.
Bill
Spine. 2005 Jul 1;30(13):1477-84.
Frequency and clinical predictors of adverse reactions to chiropractic care in
the UCLA neck pain study.
Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM.
Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA
90095-1772, USA. ehurwitz@ucla.edu
STUDY DESIGN: Randomized clinical trial. OBJECTIVES: To document the types and
frequencies of adverse reactions associated with the most common chiropractic
treatments for neck pain, and to identify possible clinical predictors of
adverse reactions to chiropractic treatment. SUMMARY OF BACKGROUND DATA:
Chiropractic care is frequently sought by patients for relief from neck pain;
however, adverse reactions related to its primary modes of treatment have not
been well examined. METHODS: A total of 336 patients with neck pain presenting
to 4 southern California health care clinics were randomized in a balanced 2 x 2
x 2 factorial design to manipulation with or without heat, and with or without
electrical muscle stimulation (EMS); and mobilization with or without heat and
with or without EMS. Discomfort or unpleasant reactions from chiropractic care
were self-assessed at 2 weeks after the randomization/baseline visit. RESULTS:
Of the 280 participants (83%) who responded, 85 (30.4%) had 212 adverse symptoms
as a result of chiropractic care. Increased neck pain or stiffness was the most
common symptom, reported by 25% of the participants. Less common were headache
and radiating pain. Patients randomized to manipulation were more likely than
those randomized to mobilization to have an adverse symptom occurring within 24
hours of treatment (adjusted odds ratio [OR] = 1.44, 95% confidence interval
[CI] = 0.83, 2.49). Heat and EMS were only weakly associated with adverse
symptoms (heat: OR = 0.94, 95% CI = 0.54, 1.62; EMS: OR = 1.09, 95% CI = 0.63,
1.89). Moderate-to-severe neck disability at baseline was strongly associated
with adverse neurologic symptoms (OR = 5.70, 95% CI = 1.49, 21.80). CONCLUSIONS:
Our results suggest that adverse reactions to chiropractic care for neck pain
are common and that despite somewhat imprecise estimation, adverse reactions
appear more likely to follow cervical spine manipulation than mobilization.
Given the possible higher risk of adverse reactions and lack of demonstrated
effectiveness of manipulation over mobilization, chiropractors should consider a
conservative approach for applying manipulation to their patients, especially
those with severe neck pain.
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