For people suffering from neck pain or low-back pain, having a physical therapist or chiropractor adjust the spine can provide exquisite relief.
But there’s controversy as to whether spinal manipulation is the best way to treat neck and back pain – and whether the practice actually is dangerous.
Experts on both sides of the issue duked it out at bmj.com Thursday afternoon, with Benedict Wand of the school of physiotherapy at University of Notre Dame Australia arguing against spinal manipulation, and David Cassidy of the division of epidemiology at the University of Toronto’s Dalla Lana School of Public Health arguing in its favor.
Spinal manipulation is the application of “thrusts” to the low back (or lumbar spine) or neck (cervical spine) to relieve pain.
In short, Wand and his colleagues say spinal manipulation hasn’t been shown to confer lasting benefit, that other interventions (such as having the patient exercise or take pain-relief medications) work at least as well if not better. That meager benefit to the patient, Wand maintains, doesn’t justify the risk (albeit a small one) of stroke and other neurovascular injuries the procedure poses.
Cassidy and his colleagues beg to differ. They write that patients seek and benefit from the pain relief spinal manipulation affords and that research supports including the procedure in the menu of treatment options. Cassidy also points out that strokes that occur after manipulations may result from underlying conditions that also cause the neck pain for which the patient sought treatment in the first place; that would suggest the spinal adjustment itself didn’t cause those strokes. He says the procedure should continue to be offered even as more research into its safety and efficacy is conducted.
The American Chiropractic Association updated its policy regarding spinal manipulation in 2003. That policy notes that the procedure has a good track record but is only safe when performed by highly trained chiropractors. But the statement’s major message is that more research is warranted.
(In a related controversy, two states – Washington and Arkansas – prohibit physical therapists from performing spinal manipulations. The American Physical Therapy Association argues that its members are well trained in performing the procedure and have a good safety record and says spinal manipulation should remain part of the physical therapist’s treatment arsenal.)
The debate is an excellent example of how frustrating and confusing medical research can be. We patients want clear guidance based on conclusive evidence, but when the studies are conflicting or their findings fuzzy, the medical community is left to sort out the science as well as it can.
What’s your opinion? Do you depend on this procedure to ward off neck pain? Or do you avoid it for fear it may cause a stroke?