Spinal Manipulation Should Not Be Routinely Used, New Study Warns
Featured ArticleMain Category: Bones / Orthopedics
Also Included In: Complementary Medicine / Alternative Medicine; Sports Medicine / Fitness; Pain / Anesthetics
Article Date: 02 Jul 2007 - 0:00 PDT
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According to a study published in the Journal of the Royal Society of Medicine, spinal manipulation should not be used routinely. Routine use of spinal manipulation on the upper spine could result in serious complications, such as stroke, and even death.
Lead researcher Edzard Ernst, Professor of Complementary Medicine at Peninsular Medical School, Universities of Exeter and Plymouth, said "Even allowing for an extraordinarily high level of under-reporting, spinal manipulation has been associated with about 600 serious adverse events. In addition, it causes non-serious adverse effects in about 50 percent of all patients who use it. If any drug were linked to such rates of harm, I somehow doubt that it would still be on the market."
Case reports, retrospective case series, prospective case series, case-controlled studies and surveys were reviewed by the Prof. Ernst. Clear evidence was found of adverse events, from low level pain to disc herniation, bone fractures, spinal cord injury and stroke.
Several studies identified a link between routine spinal manipulation when the cervical vertebrae are involved and risk of adverse effects. Prof. Ernst believes patients may not be receiving enough information regarding the risks associated with spinal manipulation that would allow them to give informed consent. It is not uncommon for serious adverse effects not to be reported in the medical literature.
Professor Ernst said "The very high level of under-reporting in this area suggests that the adverse effects that have been identified are just the tiny tip of a very large iceberg".
Dr. Kamram Abbasi, editor of the Journal of the Royal Society of Medicine said "Evaluation of non-drug interventions is a thorny issue, particularly those used in complementary therapies. The central issue here is ensuring that sufficient high-quality evidence is available for patients so that they can make an informed decision before beginning any therapy. We spend a great deal of time minutely scrutinising certain interventions, while many others offered by the health service are relatively unstudied."
What is Spinal Manipulation?
Spinal manipulation/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. It is occasionally used by osteopaths, physiotherapists and physicians, and it is the hallmark treatment of chiropractors.
"Adverse effects of spinal manipulation: A systematic review"
Professor Edzard Ernst
Journal of the Royal Society of Medicine
Link to article
Written by: Christian Nordqvist
Editor: Medical News Today
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12 Feb. 2012. <http://www.medicalnewstoday.com/articles/75754.php>
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http://www.medicalnewstoday.com/articles/75754.php.
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Response
posted by Matt on 2 Jul 2007 at 3:47 amThe article is very ambiguous and unclear. What are 'adverse effects'? Does the author realizes the percentage of strokes after cervical manipulation? It's like 1:6000000, so writing that "routine use of spinal manipulation on the upper spine could result in serious complications, such as stroke, and even death" is very non-scientific and biased. Chiropractic works and that's a fact and it's been scientifically proved in many studies. "It is not uncommon for serious adverse effects not to be reported in the medical literature". Maybe there're just not as many adverse effects as the author assumes, so that they're not reported? How about that? But of course you can always try a surgery or other medical approach, which in most cases does not work.
Comment On SMT Review Article
posted by Bruce J. Haggart D.C. on 3 Jul 2007 at 1:38 pmThe review article by E. Ernst, presented in the Journal of the Royal Society of Medicine, and reviewed in the online medical new today, was very disappointing and had questionable merit. It did not reveal significant new information. It was neither impartial, fair nor unbiased. It contained some misleading conclusions.
In North America, where the Spinal Manipulative Treatment procedure is most often performed, the procedure is defined as a physician level service, not a therapist level service. In the state of Utah where I reside and practice, this procedure is specifically limited by statute to licensed Medical physicians, Osteopathic physicians, Chiropractic physicians and Naturopathic physicians. The procedure requires physician level diagnostic, evaluative, management and technical training, clinical skills and expectations for public safety exceeding those required for other non-physician health care providers.
The author used the term Spinal Manipulation regardless of the type or class of health care provider performing the procedure. As noted on the first page of his article, that Spinal Manipulative Treatments are primarily performed by Chiropractic physicians and Chiropractors in North America. Other health care providers who are not licensed Chiropractors use hundreds of other techniques, to purposefully copy the CMT procedure in an effort to obtain known beneficial results. This is especially the case outside of North America.
Most of the references cited by the author reported problems resulting from Spinal Manipulation or Chiropractic services which were in fact were not provided by a licensed Chiropractor or Chiropractic physician. Chiropractic services are exclusive of those performed by someone who graduated from a CCE accredited college, passed the battery of National Board of Chiropractic Examiners tests and obtained a license to practice Chiropractic. The references most often noting significant and catastrophic negative outcomes from Spinal Manipulation were dealing with non-Chiropractic health care providers or lay individuals performing what was incorrectly reported or described as Chiropractic care. The author failed to recommend accountability to this other group known to be responsible for causing a disproportionately higher proportion of harm to the general public. The author also did not recommend limiting the use of CMT to physician level health care providers, such as a licensed Chiropractic physician or Chiropractor.
The author made a weakly use over the potential impact of post-market surveillance to support his position on the relative risk and benefit of NSAID use, Chiropractic Spinal Manipulative Treatment performed by a licensed Chiropractor or Chiropractic physician, exercise or massage.
The author quoted himself as cited references for his eminence-based opinion that spinal manipulation was mostly for self-limiting conditions and that the procedure had no well established effectiveness.
There is no doubt that some people have latent and transitory unwanted side effects and that a very small number of people may be injured directly due to a spinal manipulation procedure performed by a licensed Chiropractor or Chiropractic physician. However there was no excuse for this author to exaggerate the potential likelihood, severity, and duration of harm versus the potential benefit of the procedure for the general public when this procedure is performed by a properly trained, tested and licensed Chiropractor or Chiropractic physician.
Comment On SMT Review Article
posted by Dr. Gary Ayres D.C. on 28 Nov 2011 at 7:59 amThe researcher says there are 600 serious adverse events but never gives much more then that. If what I do is so serious and deadly then would it not only stand to reason that my insurance premiums would be really high also. Ask an MD (Medical Doctor) and a DC (Doctor of Chiropratic) what they pay a year in insurance costs. This article seems very anti-Chiropractic and I think it is silly. I work with my MD's and DO's in the best interests of my patients. I can't 'fix' everything and neither can they so lets work together and do the best that we can.
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