Neck manipulation may be risky without significant benefits: Study

By Dr. Ananya Mandal, MDSep 8 2010

According to new research manipulation for neck pain may carry a risk of serious injury, including stroke. For the study more than 120 patients with neck pain were included. They were randomly assigned to be treated with either manipulation or mobilization - which involves small, rhythmic movements applied to stiff or inflamed tissue. The outcome of both groups was almost identical, prompting researchers to conclude that manipulation may not be worth the risk.

Manipulation is commonly used by chiropractors, osteopaths and physiotherapists. It involves applying a rapid, small thrusting movement to the spine, producing an audible “click”.

According to lead author Dr Andrew Leaver, of the University of Sydney, neck manipulation was a “highly controversial treatment” because it was associated with an increased risk of stroke. He said that the estimates of rarity of injury with this procedure is often mistaken not taking into account unreported incidents. “It appears to be a rare occurrence, and there is still some debate about whether manipulation can cause stroke, but patients have a right to make an informed choice…[The findings] make us question why patients or practitioners would favour a treatment which possibly carries risk of catastrophic outcome over an equally effective one with very few reported complications,” he explained.

The Chiropractors Association of Australia (CAA) said its members used a range of techniques to treat pain. According to Dr Billy Chow, chiropractor and head of the CCA's Public Education committee, “There is extremely low risk associated with managing conditions such as neck pain with chiropractic care…There is no doubt that Chiropractic care remains an extremely effective way to manage neck pain ... reinforced by the fact that over 215,000 Australians seek chiropractic care every week.”

The study is published in the Archives of Physical Medicine and Rehabilitation. The research was carried out in collaboration with the University of Queensland.