Spinal manipulation is a common technique used to reduce back pain, neck pain and other musculoskeletal conditions by applying thrusts to the lumbar spine (lower back) or cervical spine (neck). Now in a report published online in British Medical Journal (BMJ) researchers debate whether it is effective.

According to Neil O’Connell and colleagues, cervical spine manipulation “may carry the potential for serious neurovascular complications” and that the technique is “unnecessary and inadvisable.”

O’Connell and his team argue that studies “provide consistent evidence of an association between neurovascular injury and recent exposure to cervical manipulation.” These types of injuries include:

  • Stroke
  • Vertebral artery dissection

    • – a tear to the lining of the vertebral artery, which is located in the neck and supplies blood to the brain

The researchers state that a Cochrane review of randomized trials of neck manipulation or mobilization found that the technique only provides moderate short term pain relief and is not likely to provide long term benefit for individuals with neck pain.

These findings were supported by other recent trials that found that manipulation is not superior than other physical interventions, such as exercise.

They conclude:

“The potential for catastrophic events and the clear absence of unique benefit lead to the inevitable conclusion that manipulation of the cervical spine should be abandoned as part of conservative care for neck pain.”

However, David Cassidy and his team state that cervical spine manipulation should not be abandoned as it is a valuable addition to patient care.

Cassidy and his colleagues state that high quality evidence “clearly suggests that manipulation benefits patients with neck pain.” Furthermore, the evidence raises doubt about any association between stroke and manipulation.

According to Cassidy, when this evidence is combined with results from randomized trials, “this evidence supports including manipulation as a treatment option for neck pain, along with other interventions such as advice to stay active and exercise.”

However, when risk, benefit, and patient preference are taken into account, “there is currently no preferred first line therapy, and no evidence that mobilization is safer or more effective than manipulation. Thus the identification of safe and effective interventions for neck pain remains a high priority,” said Cassidy.

They conclude: “We say no to abandoning manipulation and yes to more rigorous research on the benefits and harms of this and other common interventions for neck pain.”

Written By Grace Rattue