The precautionary principle or precautionary approach to risk management states that if an action or policy has a suspected risk of causing harm to the public, or to the environment, in the absence of scientific consensus that the action or policy is not harmful, the burden of proof that it is not harmful falls on those taking an action that may or may not be a risk. Although there is ongoing discussion about the safety issues associated with manipulation of the cervical spine, manual and manipulative spinal therapy defabio 1999 continue to be widely used in the treatment of cervical spine dysfunction the exact. Textbook of the cervical spine, 1st edition editors. This report presents results from the rand study on the appropriateness of spinal manipulation and mobilization of the cervical spine. Cervical spine manipulation, a procedure with a rare but. Cervicogenic headache and cervical spine manipulation. Chiropractic ignoring the precautionary principle since. Headaches are also treated by manipulation of the upper or cervical spine. Cervical rotary manipulations were thought by some respondents to be potentially dangerous. Some chiropractors claim spinal manipulation can have an effect of a variety of ailments such as irritable bowel. This type of manipulation may increase the risk of stroke and other issues, with studies suggesting the. Self manipulation of the spine brings temporary relief of. Cervical spine manipulation and the precautionary principle previous article comparison of effects of spinal manipulation and massage on motoneuron excitability next article shortterm effects of cervical manipulation on edge light pupil cycle time.
This is the first case of spontaneous intracranial hypotension in which spinal chiropractic manipulation coincided with the development of symptoms and in which a csf collection in the upper cervical and thoracic spine was demonstrated radiographically in. Spinal manipulation highvelocity lowamplitude thrust the. The study was designed to ascertain the clinical criteria for the appropriate use of cervical manipulation and mobilization to treat conditions such as neck pain and headache and to document treatment complications. A prospective national survey thiel hw, bolton je, docherty s, portlock jc. Improvements in cervical spine surgery were revolutionized as physical examinations, diagnostic imaging and development of surgical techniques and instruments progressed. Cervical spine manipulation a high velocity, low amplitude, end range thrust manoeuvre is a common treatment option for mechanical neck pain yet may carry the potential for serious neurovascular complications, specifically vertebral artery dissection and subsequent vertebrobasilar stroke. Cervical spine manipulation evidence back to chiropractic research notes bronfort, g.
Osteoporotic fracture of the dens revealed by cervical. Safety the safety of a treatment can be measured in terms of minor and major complications. Whilst this self manipulation may bring very temporary relief, inevitably there will be progressive injury to the nerve roots leading to severe arm pain. Csm, an interim approach that balances both perspectives may involve the implementation of a. Manipulation and mobilization of the cervical spine.
Prepared by internationally recognized members of the cervical spine research society editorial committee, the fifth edition presents new information, new technologies, and advances in clinical decision making. Cervical manipulation, commonly known as neck manipulation, is a procedure involving adjustment of the upper 7 vertebrae of the spinal column. Should spinal manipulation for neck pain be abandoned. Cervical spine manipulation and the precautionary principle. Authors abstract a randomized controlled trial of manipulation of the cervical spine was carried out on 52 patients in general practice, and the results were assessed symptomatically and goniometrically for three weeks. The first book ever to bring together the best techniques from chiropractic and osteopathy, this. It is now a well established fact that cervical thrust manipulation can harm the vertebral artery. The cervical spine is the most comprehensive, current, and authoritative reference on the cervical spine. Department of research and professional development, angloeuropean college of chiropractic, bournemouth, united kingdom.
Care consisting of traction for the cervical spine or flexion distraction in the lumbar spine in the acute phase, and rotational manipulation in the subacute phase, had an 80% success rate, with no complications. Flynn, pt, phd board certified in orthopaedic physical therapy fellow, american academy of orthopaedic manual physical therapists session description. Pdf cervical manipulationhow might informed consent be. There is reason to believe that spinal manipulation can temporarily relieve pain and muscle spasm by influencing pain nociceptive. The laboratory component will focus on the safe and effective delivery of thrust and nonthrust manipulation to the cervical and thoracic spine with supporting mobility and motor control exercises. Neil tucker, jennie longbottom, in acupuncture in manual therapy, 2010. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from thrust joint manipulation to the cervical spine. For example, the influence of cervical spine segments not included in the manipulation can be used to direct loads to the segment to minimise stress on. Even so, the precautionary principle must be applied i. To characterize the types of control procedures used in controlled clinical trials of cervical spine manipulation and to evaluate the outcomes obtained by subjects in control groups so as to improve the quality of future clinical trials a search of relevant clinical trials was performed in pubmed 1966may 2010 with the following key words. Alternatively, the patient may be placed in a prone position lying face down, an approach often used in lower cervicalupper thoracic.
Contents background assessment for manipulation subjective history including flags objective assessment screening tools measures maitlands grades of mobilization and manipulation appropriateness for care overview of treatment. Manipulation principles saurab sharma, mpt lecturer, kusms 2. Spinal manipulation is a technique that involves the application of various types of thrusts to the lumbar spine lower back or cervical spine neck to. Typically, chiropractic treatment plans involve some forceful and less forceful spinal adjustment techniques during the same visit or over the course of treatment 6 to 10 visits for a typical patient. American osteopathic association position paper on. American osteopathic association position paper on osteopathic manipulation treatment of the cervical spine background and statement of issue there has recently been an increasing concern about the safety of cervical spine manipulation. Chiropractors use manipulation of the cervical spine to relieve neck, upper back, shoulder, and arm pain. Osteopathic and chiropractic techniques for manual. They were performed despite the known history of osteoporosis and without previous radiographic evaluation of the cervical spine. The best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist duration. Spinal manipulation or adjustment is a manual treatment where a vertebral joint is passively moved between the normal range of motion and the limits of its normal integrity, though a universally accepted definition does not seem to exist. Manipulation of the cervical spine safety and effectiveness. From degenerative spine conditions and inflammation, to trauma and infections, it guides todays spine surgeons, orthopaedic surgeons, neurosurgeons. This procedure is most often utilized by chiropractors, as well as osteopathic physicians who practice osteopathic manipulation.
A riskbenefit assessment of chiropractic neck manipulation. Estimates range from 1 in 200,000 to 1 in several million cervical spine manipulations. Chiropractors often deny that neck manipulation can be a primary cause of stroke by injuring vertebral arteries. Then you can start reading kindle books on your smartphone, tablet, or computer no kindle device required. To meet the requirements of the principles of prevention and precaution, we believe the number of cervical manipulations should be reduced. Chiropractors adapt treatment plans to meet the specific needs of each patient. New thoughts on benefits and risks 10292011 louie puentedura and paul mintken not to be copied without permission 4 no significant interaction for ndi scores p.
Authored by a multidisciplinary team that includes orthopedists and neurosurgeons, textbook of the cervical spine is a practical, clinically focused medical reference for treating patients with the full range of cervical spine disorders. Whilst cervical manipulation is a useful method of treatment for spinal joint pain and dysfunction, it has also been. Although a wide diversity of ideas exist among chiropractors, they share the belief that the spine and health are related in a fundamental way, and that this relationship is mediated through the nervous system. Chiropractic is a pseudoscientific complementary and alternative medicine cam that is. Manipulation produced a significant immediate improvement in symptoms in those with pain or stiffness in the neck, and painparaesthesia in the shoulder. Download citation cervical spine manipulation and the precautionary principle cervical manipulations can cause severe neurologic complications, which are both exceedingly rare and generally. Im a 2nd year pt student in the middle of my ortho spine course. Cervical manipulations can cause severe neurological complications, which are both exceedingly rare and generally unpredictable. The appropriateness of manipulation and mobilization of. The 2008 book trick or treatment states xrays can reveal neither the. We studied treatment outcomes obtained from 19,722 patients. The cervical spine and millions of other books are available for amazon kindle. A clinical prediction rule for patients with neck pain who responded favorably to cervical thrust joint manipulation tjm.
Rationale use of manipulation in cervical spine disorders. Principles of manipulation or manipulative therapy 1. He serves on the faculty of the department of osteopathic manipulation at the university of paris. Anxiety about complications was a prominent reason for not using manipulation. Rationale use of manipulation in cervical spine disorders timothy w. Cervical manipulations can cause severe neurological complications, which are both exceedingly. Cervical artery dissectionclinical features, risk factors, therapy and outcome in 126 patients.
Adverse events, case reports, cervical spine, manipulation, risk of harm, safety introduction cervical spine manipulation csm is utilized by physical therapists, chiropractors, and other healthcare practitioners to treat a multitude of disorders, most commonly headaches, neck pain, and stiffness. Some chiropractors claim spinal manipulation can have an effect on a variety of. Chiropractors have proposed, especially those in the fields early history, that such disorders affect general health via the nervous system. There is always risk associated with the management of patient with head and neck disorders. Chiropractic adjustment spinal manipulation of the cervical spine is usually accomplished with the patient either lying down on his or her back, or in a seated position. Research report by new zealand journal of physiotherapy.
The cervical manipulations were probably a contributory factor rather than the inciting cause. Chiropractic is a discipline that is concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine. Cervical spine manipulation, a procedure with a rare but potentially serious adverse reaction. Alexander technique for nonsurgical treatment of the cervical herniated disc duration. In the 1980s, there was a better understanding of the cervical spine, including how pathological changes could lead to. Enter your mobile number or email address below and well send you a link to download the free kindle app. Manipulating the cervical spine may have some neurophysiological effects in relieving head and neck pain as well as a mechanical effect in restoring mobility in cervical joints. The risk of a serious adverse event following chiropractic manipulation of the cervical spine is largely unknown.
Professor wand and colleagues state that although manipulation of the cervical spine is a common treatment option for muscular neck pain, it carries the risk of causing a bleed of the vertebral artery, which would result in a vertebrobasilar stroke. His courses cover osteopathic spinal manipulation, articulation and advanced soft tissue. Spontaneous vertebral fractures located in the upper thoracic spine above t7 or in the cervical spine should suggest a tumor. Specifically, this concern has centered on devastating negative outcomes such as stroke. Health, general decision making health aspects decisionmaking pain care and treatment pain management. A cervical spine dysfunction may be the primary cause of restricted joint movement in the lumbar spine or vice versa. As a result, in appropriate cases cervical manipulation may be a necessary and effective treatment for back pain. The ultimate goal of chiropractic treatment is to restore proper alignment to the spine in order to let the body heal itself. Adams and sim posted a questionnaire about adverse effects of spinal manipulation to 300 uk manipulative therapists. There is regrettably no research on this difficult question, but there is no doubt in my mind that too many adjustments of any single joint, simply adds to the problem rather than the solution. Safety of chiropractic manipulation of the cervical spine. The vertebral arteries supply the brainstem and cerebellum at the base of the brain.