Cervical manipulation: How risky is it?

Although the article by John Norris and colleagues on sudden neck movement and cervical artery dissection mentions only chiropractic manipulation,¹ all health care providers who use cervical manipulation should be cognizant of the adverse consequences. Indeed, in some provinces cervical manipulation has been put on a list of restricted medical procedures that may be carried out only by licensed practitioners.

There is an abundance of information in the literature on the relative and absolute contraindications for manipulation as well as on the screening that must take place before this technique is used. However, there are other considerations that out of professional courtesy are frequently not mentioned. For example, practitioners who lack skill and experience may compensate by using excessive force. Experienced practitioners tend to avoid nonspecific general rotational techniques, especially in combination with extension, when treating the upper cervical spine. The chiropractic literature suggests that rotational techniques, especially when used in the upper cervical spine, are more dangerous than nonrotational ones.² There is little if any non- anecdotal evidence to refute the notion that nonspecific rotational techniques may be dangerous.

It is the responsibility of the practitioner to minimize the risks of spinal manipulation. It is unreasonable to hide behind the lack of hard evidence proving the presence or frequency of these risks. After all, the absence of proof is not the same as the absence of fact; it simply demonstrates the lack of adequate research. Alternative techniques that do not utilize gross rotation have been used successfully for many years with no known resultant deaths and thus are supported by the Canadian Orthopractic Manual Therapy Association.

Signature

Robert Sydenham
President Canadian Orthopractic Manual Therapy Association Edmonton, Alta.