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| {{For| detail of manipulation in individual synovial joints|Joint manipulation}} | {{For| detail of manipulation in individual synovial joints|Joint manipulation}} | ||
| ] | |||
| {{For| the ] approach|Spinal adjustment}} | |||
| '''Spinal manipulation''' is a therapeutic intervention performed on spinal articulations which are ]. These articulations in the spine that are amenable to spinal manipulative therapy include the ], the ], ], ], ], ] and ] joints. | |||
| '''Spinal manipulation''' is a therapeutic intervention used to treatment dysfunctional joints in the hopes of reducing ] and ] of the neuromusculoskeletal system. The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. ], the "father of medicine" used manipulative techniques,<ref name=Swedlo>{{cite conference |url=http://www.hom.ucalgary.ca/Dayspapers2002.pdf |format=PDF |booktitle= Proc 11th Annual History of Medicine Days |editor= Whitelaw WA (ed.) |title= The historical development of chiropractic |publisher= ] |pages= 55–58 |author= Swedlo DC |date=2002 |accessdate=2008-05-14}}</ref> as did the ancient Egyptians and many other cultures. A modern re-emphasis on ] occurred in the late 19th century in North America with the emergence of the ] and ].<ref name=Keating-pathways>{{cite journal |journal= J Manipulative Physiol Ther |date=2003 |volume=26 |issue=5 |pages=300–21 |title= Several pathways in the evolution of chiropractic manipulation |author= Keating JC Jr |doi=10.1016/S0161-4754(02)54125-7 |pmid=12819626}}</ref> SMT gained mainstream recognition during the 1980s.<ref>{{cite web |url=http://muaphysicians.com/historical.html |publisher= International MUA Academy of Physicians |title= Manipulation under anesthesia: historical considerations |author= Francis RS |date=2005 |accessdate=2008-07-06}}</ref> Spinal manipulation/adjustment describes techniques where the hands are used to manipulate, ], ], adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues.<ref name=ACA-SMP>{{cite web |url=http://acatoday.org/pdf/spinal_manipulation_policy.pdf |format=PDF |title= Spinal manipulation policy statement |author= Winkler K, Hegetschweiler-Goertz C, Jackson PS ''et al.'' |accessdate=2008-05-24 |date=2003 |publisher= American Chiropractic Association}}</ref> It is the most common and primary intervention used in chiropractic care.<ref name=NBCE_techniques/> In North America, chiropractors perform over 90% of all manipulative treatments<ref>{{cite web |url=http://nccam.nih.gov/health/chiropractic/chiropractic05.pdf |format=PDF |title= About chiropractic and its use in treating low-back pain |accessdate=2008-03-24 |date=2005 |publisher=] |archiveurl = http://web.archive.org/web/20080227113930/http://nccam.nih.gov/health/chiropractic/chiropractic05.pdf <!-- Bot retrieved archive --> |archivedate = 2008-02-27}}</ref> with the balance provided by ], ] and ]. ] or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia.<ref>{{cite journal |journal= J Manipulative Physiol Ther |date=2005 |volume=28 |issue=7 |pages=526–33 |title= Manipulation under anesthesia: a report of four cases |author= Cremata E, Collins S, Clauson W, Solinger AB, Roberts ES |doi=10.1016/j.jmpt.2005.07.011 |pmid=16182028}}</ref> Typically, it is performed on patients who have failed to respond to other forms of treatment.<ref>{{cite journal |journal=J Manipulative Physiol Ther |date=2000 |volume=23 |issue=2 |pages=127–9 |title=Manipulation under joint anesthesia/analgesia: a proposed interdisciplinary treatment approach for recalcitrant spinal axis pain of synovial joint origin |author=Michaelsen MR |doi=10.1016/S0161-4754(00)90082-4 |pmid=10714542 |url=http://www.jmptonline.org/article/S0161-4754(00)90082-4/abstract}}</ref>There has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine.<ref name=Ernst-adverse>{{cite journal |pmid=17606755 |doi=10.1258/jrsm.100.7.330 |laysummary=http://www.medicalnewstoday.com/articles/75754.php |laysource=Med News Today |laydate=2 July 2007 |year=2007 |month=Jul |last1=Ernst |first1=E |title=Adverse effects of spinal manipulation: a systematic review |volume=100 |issue=7 |pages=330–8 |issn=0141-0768 |journal=Journal of the Royal Society of Medicine |pmc=1905885}}</ref> Although serious injuries and fatal consequences can occur and are likely to be under-reported,<ref name=Ernst-death>{{cite journal |journal= Int J Clinical Practice |year=2010 |volume=64 |issue= 8 |pages=1162–1165 |title= Deaths after chiropractic: a review of published cases |author= E Ernst |pmid=20642715 |doi=10.1111/j.1742-1241.2010.02352.x}}</ref> these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.<ref name=WHO-guidelines/> | |||
| == History == | |||
| Spinal manipulation is a therapeutic intervention that has roots in ] and has been used by various cultures, apparently for thousands of years. ], the "father of medicine" used manipulative techniques,<ref name=Swedlo>Dean C. Swedlo, "" pp. 55-58, ''The Proceedings of the 11th Annual History of Medicine Days'', Faculty of Medicine, The University of Calgary</ref> as did the ancient Egyptians and many other cultures.<ref name=Burke>Burke, G.L., "" Chapter 1</ref> A modern re-emphasis on ] occurred in the late 19th century in North America with the emergence of ] and ] medicine.<ref name=Keating-pathways>{{cite journal |journal= J Manipulative Physiol Ther |year=2003 |volume=26 |issue=5 |pages=300–21 |title= Several pathways in the evolution of chiropractic manipulation |author= Keating JC Jr |doi=10.1016/S0161-4754(02)54125-7 |pmid=12819626}}</ref> Spinal manipulative therapy gained recognition by mainstream medicine during the 1960s.<ref name=Burke2>Burke, G.L., "" Chapter 7</ref><ref name="titleInternational MUA Academy of Physicians - Historical Considerations">{{cite web |url=http://www.muaphysicians.com/historical.html |title=International MUA Academy of Physicians - Historical Considerations |accessdate=2008-03-24 |author= |authorlink= |coauthors= |date= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote=}}</ref> | |||
| ==Research== | |||
| == Current providers == | |||
| In 1975, legitimate scientific investigation from the ], ] and ] communities were invited to attended the first research symposium on spinal manipulation at the National Institute of Health (NIH.) Basic science studies presented were in anatomy, biochemistry, biomechanics, and neuroscience. Clinical investigators with chiropractic, osteopathic and medical backgrounds presented papers on research findings from pathology, radiology and clinical evaluations; the latter being primarily observational studies. <ref>{{cite web|last=Goldstein|first=Murray|title=Historical Perspective: The Research Status of Spinal Manipulative Therapy (1975)|url=http://nccam.nih.gov/news/events/Manual-Therapy/historical.htm#note|publisher=NCCAM|accessdate=8 February 2013}}</ref> In the 1980s, spinal manipulation had gained mainstream acceptance,<ref>{{cite web |url=http://muaphysicians.com/historical.html |publisher= International MUA Academy of Physicians |title= Manipulation under anesthesia: historical considerations |author= Francis RS |date=2005 |accessdate=2008-07-06}}</ref>which has led to increased collaboration with medical practitioners on models for the delivery manual and manipulative therapies for spinal and musculoskeletal conditions.<ref name="DeVocht-JW">{{cite journal|journal=Clin Orthop Relat Res|year=2006|volume=444|pages=243–9|title=History and overview of theories and methods of chiropractic: a counterpoint|author=DeVocht JW|doi=10.1097/01.blo.0000203460.89887.8d|pmid=16523145 }}</ref><ref>{{cite journal|coauthors=Mior S, Barnsley J, Boon H, Ashbury FD, Haig R.|title=Designing a framework for the delivery of collaborative musculoskeletal care involving chiropractors and physicians in community-based primary care.|journal=J Interprof Care|year=2010|month=Nov|volume=24|issue=6|pages=678–89|pmid=20441400|accessdate=4 February 2013}}</ref><ref>{{cite journal|coauthors=Mior S, Gamble B, Barnsley J, Côté P, Côté E.|title=Changes in primary care physician's management of low back pain in a model of interprofessional collaborative care: an uncontrolled before-after study.|journal=Chiropr Man Therap|year=2013|month=Feb|volume=21|issue=1|accessdate=4 February 2013}}</ref> | |||
| Spinal manipulation is now most commonly provided various health care disciplines. In ], it is most commonly performed by ]s, ], ] and ]s. In ], ], ] and ] are the majority providers, although the precise figure varies between countries. | |||
| == Terminology == | == Terminology == | ||
| High-velocity low amplitude {HVLA) manipulative therapy is also known as adjustment and Grade V mobilisation.<ref>Maitland, G.D. ''Peripheral Manipulation'' 2nd ed. Butterworths, London, 1977. | |||
| Manipulation is known by several other names. The British orthopaedic surgeon ] used the term "manipulation" in his text ''Manipulative Surgery''.<ref> A. S. Blundell Bankart. . 1932. London: Constable & Co.</ref> Chiropractors often refer to manipulation of a spinal joint as an ']'. Following the labelling system developed by Geoffery Maitland,<ref>Maitland, G.D. ''Peripheral Manipulation'' 2nd ed. Butterworths, London, 1977.<br> | |||
| Maitland, G.D. ''Vertebral Manipulation'' 5th ed. Butterworths, London, 1986.</ref> Chiropractors and some osteopaths prefer to use the term "adjustment," a term which reflects "their belief in the therapeutic and health-enhancing effect of correcting spinal joint abnormalities."<ref name=crossroads>{{cite journal |journal= Ann Intern Med |year=2002 |volume=136 |issue=3 |pages=216–27 |title= Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine |author= Meeker WC, Haldeman S |pmid=11827498 |url=http://www.annals.org/cgi/reprint/136/3/216.pdf |format=PDF}}</ref> | |||
| Maitland, G.D. ''Vertebral Manipulation'' 5th ed. Butterworths, London, 1986.</ref> manipulation is synonymous with Grade V ]. Because of its distinct biomechanics (see section below), the term ] (HVLA) thrust is often used interchangeably with manipulation. | |||
| ==Manual and manipulative therapy== | |||
| == Biomechanics == | |||
| The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. ], the "father of medicine" used manipulative techniques,<ref name=Swedlo>{{cite conference |url=http://www.hom.ucalgary.ca/Dayspapers2002.pdf |format=PDF |booktitle= Proc 11th Annual History of Medicine Days |editor= Whitelaw WA (ed.) |title= The historical development of chiropractic |publisher= ] |pages= 55–58 |author= Swedlo DC |date=2002 |accessdate=2008-05-14}}</ref> as did the ancient Egyptians and many other cultures. A modern re-emphasis on ] occurred in the late 19th century in North America with the emergence of the ] and ].<ref name=Keating-pathways>{{cite journal |journal= J Manipulative Physiol Ther |date=2003 |volume=26 |issue=5 |pages=300–21 |title= Several pathways in the evolution of chiropractic manipulation |author= Keating JC Jr |doi=10.1016/S0161-4754(02)54125-7 |pmid=12819626}}</ref> SMT gained mainstream recognition during the 1980s.<ref>{{cite web |url=http://muaphysicians.com/historical.html |publisher= International MUA Academy of Physicians |title= Manipulation under anesthesia: historical considerations |author= Francis RS |date=2005 |accessdate=2008-07-06}}</ref> Spinal manipulation/adjustment describes techniques where the hands are used to manipulate, ], ], adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues.<ref name=ACA-SMP>{{cite web |url=http://acatoday.org/pdf/spinal_manipulation_policy.pdf |format=PDF |title= Spinal manipulation policy statement |author= Winkler K, Hegetschweiler-Goertz C, Jackson PS ''et al.'' |accessdate=2008-05-24 |date=2003 |publisher= American Chiropractic Association}}</ref> It is the most common and primary intervention used in chiropractic care;<ref name=NBCE_techniques/> In North America, chiropractors perform over 90% of all manipulative treatments<ref>{{cite web |url=http://nccam.nih.gov/health/chiropractic/chiropractic05.pdf |format=PDF |title= About chiropractic and its use in treating low-back pain |accessdate=2008-03-24 |date=2005 |publisher=] |archiveurl = http://web.archive.org/web/20080227113930/http://nccam.nih.gov/health/chiropractic/chiropractic05.pdf <!-- Bot retrieved archive --> |archivedate = 2008-02-27}}</ref> with the balance provided by the ], ] professions. ] or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia.<ref>{{cite journal |journal= J Manipulative Physiol Ther |date=2005 |volume=28 |issue=7 |pages=526–33 |title= Manipulation under anesthesia: a report of four cases |author= Cremata E, Collins S, Clauson W, Solinger AB, Roberts ES |doi=10.1016/j.jmpt.2005.07.011 |pmid=16182028}}</ref> Typically, it is performed on patients who have failed to respond to other forms of treatment.<ref>{{cite journal |journal=J Manipulative Physiol Ther |date=2000 |volume=23 |issue=2 |pages=127–9 |title=Manipulation under joint anesthesia/analgesia: a proposed interdisciplinary treatment approach for recalcitrant spinal axis pain of synovial joint origin |author=Michaelsen MR |doi=10.1016/S0161-4754(00)90082-4 |pmid=10714542 |url=http://www.jmptonline.org/article/S0161-4754(00)90082-4/abstract}}</ref>There has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine.<ref name=Ernst-adverse>{{cite journal |pmid=17606755 |doi=10.1258/jrsm.100.7.330 |laysummary=http://www.medicalnewstoday.com/articles/75754.php |laysource=Med News Today |laydate=2 July 2007 |year=2007 |month=Jul |last1=Ernst |first1=E |title=Adverse effects of spinal manipulation: a systematic review |volume=100 |issue=7 |pages=330–8 |issn=0141-0768 |journal=Journal of the Royal Society of Medicine |pmc=1905885}}</ref> Although serious injuries and fatal consequences can occur and may be under-reported,<ref name=Ernst-death>{{cite journal |journal= Int J Clinical Practice |year=2010 |volume=64 |issue= 8 |pages=1162–1165 |title= Deaths after chiropractic: a review of published cases |author= E Ernst |pmid=20642715 |doi=10.1111/j.1742-1241.2010.02352.x}}</ref> these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.<ref name=WHO-guidelines/> Manual and manipulative techniques can be categorized by different modes depending on therapeutic intent, indications, contraindications and safety.<ref name=CCA> Canadian Chiropractic Association</ref> Manual and mechanically assisted manipulative procedures can include: | |||
| Spinal manipulation can be distinguished from other ] interventions such as ] by its ], both ] and ]. | |||
| *HVLA thrust manipulation | |||
| === Kinetics === | |||
| *HVLA thrust manipulation with recoil | |||
| Until recently, force-time histories measured during spinal manipulation were described as consisting of three distinct phases: the preload (or prethrust) phase, the thrust phase, and the resolution phase{{Technical-statement|date=July 2011}}.<ref>{{cite journal | author = Herzog W, Symons B. | title = The biomechanics of spinal manipulation. | journal = Crit Rev Phys Rehabil Med | volume = 13 | issue = 2 | pages = 191–216 | year = 2001}}</ref> Evans and Breen<ref>{{cite journal | author = Evans DW, Breen AC. | title = A biomechanical model for mechanically efficient cavitation production during spinal manipulation: prethrust position and the neutral zone. | journal = J Manipulative Physiol Ther | volume = 29 | issue = 1 | pages = 72–82 | year = 2006 | pmid = 16396734 | doi = 10.1016/j.jmpt.2005.11.011}}</ref> added a fourth ‘orientation’ phase to describe the period during which the patient is ] into the appropriate position in preparation for the prethrust phase. | |||
| *LVLA manipulation (mobilization) | |||
| *Drop tables and terminal point manipulative thrust | |||
| *Flexion-distraction and traction-type tables | |||
| *Pelvic blocks | |||
| *Instrument assisted manipulative devices | |||
| Manual non-articular manipulative procedures can include: | |||
| === Kinematics === | |||
| *Manual reflex and muscle relaxation procedures | |||
| The ] of a complete ], when one of its constituent spinal joints is manipulated, are much more complex than the kinematics that occur during manipulation of an independent peripheral ]. | |||
| *Muscle energy techniques | |||
| *Reflex techniques | |||
| *Myofascial ischemic compression procedures | |||
| *Myofascial, and soft tissue manipulative techniques | |||
| ===Scientific investigation=== | |||
| == Suggested mechanisms of action and clinical effects == | |||
| ====Musculoskeletal disorders==== | |||
| The effects of spinal manipulation have been shown to include: | |||
| ] | |||
| The use of manual and manipulative therapies is a commonly used intervention used by manual medicine practitioners in the treatment of neuromusculoskeletal disorders. Spinal manipulation, in particular is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain<ref name="smt and visceral responses">{{cite journal|coauthors=Bolton PS, Budgell B.|title=Visceral responses to spinal manipulation|journal=J Electromyogr Kinesiol.|year=2012|month=Oct|volume=22|issue=5|pages=777-84.|pmid=22440554|accessdate=10 February 2013}}</ref> Manual therapies, including spinal manipulation, commonly used by chiropractors and other manual medicine practitioners are effective for the treatment of spinal pain, including low back pain, neck pain, some forms of headache and a number of extremity joint conditions such as shoulder and hip pain. Specifically, spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain<ref name=Bronfort-Haas>{{cite journal|journal= Chiropractic & Osteopathy|year=2010|volume=18|issue=3|title= Effectiveness of manual therapies: the UK evidence report|author= Bronfort G, Haas M, Evans R, Leininger B, Triano J|doi=10.1186/1746-1340-18-3|pmid=20184717|url=http://chiromt.com/content/18/1/3|pmc=2841070|page= 3}}</ref>and might also be effective for the treatment of lumbar disc herniation with radiculopathy,<ref name="Leininger B, Bronfort G, Evans R, Reiter T 2011 105–25">{{cite journal|journal= Phys Med Rehabil Clin N Am|year=2011|volume=22|issue=1|pages=105–25|title= Spinal manipulation or mobilization for radiculopathy: a systematic review|author= Leininger B, Bronfort G, Evans R, Reiter T|pmid=21292148|doi=10.1016/j.pmr.2010.11.002}}</ref><ref name="Hahne AJ, Ford JJ, McMeeken JM 2010 E488–504">{{cite journal|journal= Spine|year=2010|volume=35|issue=11|pages=E488–504|title= Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review|author= Hahne AJ, Ford JJ, McMeeken JM|pmid=20421859|doi=10.1097/BRS.0b013e3181cc3f56}}</ref> neck pain,<ref name="Gross A, Miller J, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL 2010 315–333">{{cite journal|journal= Manual Therapy|year= 2010|volume=15|issue=4|pages=315–333|title= Manipulation or mobilisation for neck pain: a Cochrane Review|author= Gross A, Miller J, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL|pmid=20510644|doi= 10.1016/j.math.2010.04.002 }}</ref> some forms of headache,<ref name="Chaibi A, Tuchin PJ, Russell MB 2011">{{cite journal|journal= J Headache Pain|year=2011|volume= 12|issue= 2|pages= 127–33|title= Manual therapies for migraine: a systematic review|author= Chaibi A, Tuchin PJ, Russell MB|pmid=21298314|doi=10.1007/s10194-011-0296-6|pmc=3072494}}</ref><ref name="Bronfort G, Nilsson N, Haas M et al. 2004 CD001878">{{cite journal|journal= Cochrane Database Syst Rev|year=2004|issue=3|pages=CD001878|title= Non-invasive physical treatments for chronic/recurrent headache|author= Bronfort G, Nilsson N, Haas M ''et al.''|doi=10.1002/14651858.CD001878.pub2|pmid=15266458|editor1-last= Brønfort|editor1-first= Gert}}</ref> and some extremity joint conditions.<ref name="Brantingham JW, Globe G, Pollard H, Hicks M, Korporaal C, Hoskins W 2009 53–71">{{cite journal|author= Brantingham JW, Globe G, Pollard H, Hicks M, Korporaal C, Hoskins W|title= Manipulative therapy for lower extremity conditions: expansion of literature review|journal= J Manipulative Physiol Ther|volume=32|issue=1|pages=53–71|year=2009|pmid=19121464|doi=10.1016/j.jmpt.2008.09.013}}</ref><ref name="pmid21109059">{{Cite pmid|21109059}}</ref> Investigation of the effectiveness of spinal manipulation for specific musculoskeletal complaints include: | |||
| *''']'''. Most studies suggest spinal manipulation achieves equivalent or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up.<ref name=Dagenais-2010>{{cite journal|journal= ]|year=2010|volume=10|issue=10|pages=918–940|title= NASS Contemporary Concepts in Spine Care: Spinal manipulation therapy for acute low back pain|author= Dagenais S, Gay RE, Tricco AC, Freeman MD, Mayer JM|doi=10.1016/j.spinee.2010.07.389|pmid=20869008}}</ref> A 2008 review found strong evidence that SM is similar in effect to medical care with exercise.<ref name=Bronfort-2008>{{cite journal|journal= ]|year=2008|volume=8|issue=1|pages=213–25|title= Evidence-informed management of chronic low back pain with spinal manipulation and mobilization|author= Bronfort G, Haas M, Evans R, Kawchuk G, Dagenais S|doi=10.1016/j.spinee.2007.10.023|pmid=18164469}}</ref> A 2008 literature synthesis found good evidence supporting SM for low back pain regardless of duration.<ref name=Lawrence-2008>{{cite journal|title= Chiropractic management of low back pain and low back-related leg complaints: a literature synthesis|author= Lawrence DJ, Meeker W, Branson R ''et al.''|journal= J Manipulative Physiol Ther|volume=31|issue=9|pages=659–74|year=2008|pmid=19028250|doi=10.1016/j.jmpt.2008.10.007}} An earlier, freely readable version is in: {{cite web|title= Chiropractic management of low back pain and low back related leg complaints|author= Meeker W, Branson R, Bronfort G ''et al.''|url=http://ccgpp.org/lowbackliterature.pdf|format=PDF|year=2007|accessdate=2008-11-28|publisher= ]}}</ref> The ] and the ] jointly recommended that clinicians consider spinal manipulation for patients who do not improve with self care options.<ref>{{cite journal |journal= Ann Intern Med |date= October 2, 2007 |volume=147 |issue=7 |pages=478–91 |title= Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society |author= Chou R |pmid=17909209 |url=http://annals.org/cgi/content/full/147/7/478 |author-separator= , |author2= Qaseem A |author3= Snow V |display-authors= 3 |last4= Casey |first4= D |last5= Cross Jr |first5= JT |last6= Shekelle |first6= P |last7= Owens |first7= DK |author8= Clinical Efficacy Assessment Subcommittee of the American College of Physicians |last9= American College Of |first9= Physicians |doi=10.7326/0003-4819-147-7-200710020-00006}}</ref> | |||
| * Temporary relief of musculoskeletal ] | |||
| * ''']'''. There is moderate quality evidence to support the use of spinal manipulation for the treatment of acute ]<ref name="Leininger B, Bronfort G, Evans R, Reiter T 2011 105–25"/> and acute lumbar ] with associated radiculopathy.<ref name="Hahne AJ, Ford JJ, McMeeken JM 2010 E488–504"/> The evidence for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration is low or very low and no evidence exists for the treatment of thoracic radiculopathy.<ref name="Leininger B, Bronfort G, Evans R, Reiter T 2011 105–25"/> | |||
| * ''']'''. Manual therapies, including spinal manipulation, has been found to be effective for mechanical neck pain.<ref name=Bronfort-Haas>{{cite journal|journal= Chiropractic & Osteopathy|year=2010|volume=18|issue=3|title= Effectiveness of manual therapies: the UK evidence report|author= Bronfort G, Haas M, Evans R, Leininger B, Triano J|doi=10.1186/1746-1340-18-3|pmid=20184717|url=http://chiromt.com/content/18/1/3|pmc=2841070|page= 3}}</ref> <ref>{{cite journal|coauthors=Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J, Peloso PM, Holm LW, Côté P, Hogg-Johnson S, Cassidy JD, Haldeman S; Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.|title=Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.|journal=Spine|year=2008|month=Feb|volume=33|issue=4|pages=123-152|pmid=18204386|accessdate=9 February 2013}}</ref><ref name=Vernon>{{cite journal|journal= ]|year=2007|volume=43|issue=1|pages=91–118|title= Manual therapy for neck pain: an overview of randomized clinical trials and systematic reviews|author= Vernon H, Humphreys BK|pmid=17369783|url=http://www.minervamedica.it/en/getfreepdf.php?cod=R33Y2007N01A0091|format=PDF}}</ref><ref name=Hurwitz-2008/><ref name=CCA-CFCREAB-CPG/> Thoracic spinal manipulation (TSM) has a therapeutic benefit to some patients with neck pain and therefore TSM or in combination with other interventions is a suitable intervention to use in the treatment of non-specific neck pain.<ref>{{cite journal|coauthors=Huisman PA, Speksnijder CM, de Wijer A.|title=The effect of thoracic spine manipulation on pain and disability in patients with non-specific neck pain: a systematic review.|journal=Disabil Rehabil.|year=2013|month=Jan|pmid=23339721|accessdate=26 January 2013}}</ref> | |||
| * ''']''' Spinal manipulation, improves migraine and cervicogenic headaches but cautioned type, frequency, dosage, and duration of treatments should be based on guideline recommendations, clinical experience, and findings. Evidence for the use of spinal manipulation as an isolated intervention for patients with tension-type headache remains equivocal.<ref>{{cite journal|coauthors=Bryans R, Descarreaux M, Duranleau M, Marcoux H, Potter B, Ruegg R, Shaw L, Watkin R, White E.|title=Evidence-based guidelines for the chiropractic treatment of adults with headache.|journal=J Manipulative Physiol Ther.|year=2011|month=June|volume=34(5)|issue=5|pages=274-89|pmid=21640251|accessdate=9 February 2013}}</ref> SM might be as effective as ] or ] in the prevention of ]s,<ref name="Chaibi A, Tuchin PJ, Russell MB 2011"/> | |||
| *'''Cervicogenic dizziness''' There is moderate evidence to support the use of manual therapy for cervicogenic dizziness.<ref>{{cite journal|journal=Chiropractic and Manual Therapies|year=2011|volume=19|issue= 1|page=21|title= Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review|author= Lystad RP, Bell G, Bonnevie-Svendsen M, Carter CV|url=http://chiromt.com/content/19/1/21/abstract|doi=10.1186/2045-709X-19-21|pmid=21923933|pmc=3182131 }}</ref> | |||
| * '''Extremity conditions'''. Manual mobilizations to an exercise program for the treatment of knee osteoarthritis resulted in better pain relief then a supervised exercise program alone and suggested that manual therapists consider adding manual mobilisation to optimise supervised active exercise programs.<ref>{{cite journal|author= Jansen MJ, Viechtbauer W, Lenssen AF, Hendriks EJ, de Bie RA|title= Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review|journal= J Physiother|volume=57|issue=1|pages=11–20|year=2011|pmid=21402325|doi=10.1016/S1836-9553(11)70002-9}}</ref> There is silver level evidence that manual therapy is more effective than exercise for the treatment of hip osteoarthritis, however this evidence could be considered to be inconclusive.<ref>{{cite journal|journal= Man Ther|year=2011|volume=16|issue=2|pages=109–117|title= Manual therapy for osteoarthritis of the hip or knee - a systematic review|author= French HP, Brennan A, White B, Cusack T|doi= 10.1016/j.math.2010.10.011|pmid=21146444}}</ref> The addition of cervical spine mobilization to a treatment regimen for lateral epicondylosis (]) result in significantly better pain relief and functional improvements in both the short and long-term.<ref>{{cite journal|journal= Journal of Manual & Manipulative Therapy|year=2008|volume=16|issue=4|pages=225–37|title= A Systematic Review of the Effectiveness of Manipulative Therapy in Treating Lateral Epicondylalgia|author= Herd CR, Meserve BB.|doi= 10.1179/106698108790818288|pmid=19771195|pmc= 2716156}}</ref> There is a small amount of research into the efficacy of chiropractic treatment for ]s,<ref>{{cite journal|journal= J Manipulative Physiol Ther|year=2008|volume=31|issue=2|pages=146–59|title= Chiropractic treatment of upper extremity conditions: a systematic review|author= McHardy A, Hoskins W, Pollard H, Onley R, Windsham R|doi=10.1016/j.jmpt.2007.12.004|pmid=18328941}}</ref> limited to low level evidence supporting chiropractic management of ]<ref name="pmid21109059"/> and limited or fair evidence supporting chiropractic management of ] conditions.<ref name="Brantingham JW, Globe G, Pollard H, Hicks M, Korporaal C, Hoskins W 2009 53–71"/> | |||
| ====Non-musculoskeletal==== | |||
| * Shortened time to recover from ] ] | |||
| The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic.<ref name=Bronfort-Haas>{{cite journal|journal= Chiropractic & Osteopathy|year=2010|volume=18|issue=3|title= Effectiveness of manual therapies: the UK evidence report|author= Bronfort G, Haas M, Evans R, Leininger B, Triano J|doi=10.1186/1746-1340-18-3|pmid=20184717|url=http://chiromt.com/content/18/1/3|pmc=2841070|page= 3}}</ref> | |||
| <ref>{{cite journal|journal=Spine|year=2007|volume=32|issue= 19 Suppl|pages=S130–4|title= A systematic literature review of nonsurgical treatment in adult scoliosis|author= Everett CR, Patel RK|doi=10.1097/BRS.0b013e318134ea88|pmid=17728680}}</ref> and no scientific data for ] adolescent scoliosis.<ref>{{cite journal|journal=]|year=2008|volume=3|page=2|title= Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review|author= Romano M, Negrini S|doi=10.1186/1748-7161-3-2|pmid=18211702|url=http://scoliosisjournal.com/content/3/1/2|pmc=2262872|issue=1}}</ref> | |||
| ===Cost-effectiveness=== | |||
| Spinal manipulation used clinical practice can be cost-effective treatment when used alone or in combination with other treatment approaches.<ref>{{cite journal|journal= J Electromyogr Kinesiol|year=2012|volume=|issue=|pages=|title=Spinal manipulation epidemiology: Systematic review of cost effectiveness studies|author= Michaleff ZA, Lin CW, Maher CG, van Tulder MW|doi= 10.1016/j.jelekin.2012.02.011|pmid=22429823|pmc= }}</ref> Evidence supporting the cost-effectiveness of using spinal manipulation for the treatment of sub-acute or chronic low back pain; the results for acute low back pain were inconsistent.<ref>{{cite journal|journal= European Spine Journal|year=2011|volume=20|issue=7|pages=1024–1038|title=Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review|author= Lin CW, Haas M, Maher CG, Machado LA, van Tulder MW|doi=10.1007/s00586-010-1676-3|pmid=21229367|pmc= 3176706 }}</ref> | |||
| ==Biomechanics == | |||
| The ] of a complete ], when one of its constituent spinal joints is manipulated, are much more complex than the kinematics that occur during manipulation of an independent peripheral ]. | |||
| Until recently, force-time histories measured during spinal manipulation were described as consisting of three distinct phases: the preload (or prethrust) phase, the thrust phase, and the resolution phase{{Technical-statement|date=July 2011}}.<ref>{{cite journal | author = Herzog W, Symons B. | title = The biomechanics of spinal manipulation. | journal = Crit Rev Phys Rehabil Med | volume = 13 | issue = 2 | pages = 191–216 | year = 2001}}</ref> Evans and Breen<ref>{{cite journal | author = Evans DW, Breen AC. | title = A biomechanical model for mechanically efficient cavitation production during spinal manipulation: prethrust position and the neutral zone. | journal = J Manipulative Physiol Ther | volume = 29 | issue = 1 | pages = 72–82 | year = 2006 | pmid = 16396734 | doi = 10.1016/j.jmpt.2005.11.011}}</ref> added a fourth ‘orientation’ phase to describe the period during which the patient is ] into the appropriate position in preparation for the prethrust phase. | |||
| == Effects == | |||
| The neurophysiological effects of spinal manipulation have been shown to include: | |||
| * Temporary increase in passive range of motion (ROM)<ref>{{cite journal | author = Nilsson N, Christensen H, Hartvigsen J | title = Lasting changes in passive range motion after spinal manipulation: a randomized, blind, controlled trial. | journal = J Manipulative Physiol Ther | volume = 19 | issue = 3 | pages = 165–8 | year = 1996| pmid = 8728459}}</ref> | * Temporary increase in passive range of motion (ROM)<ref>{{cite journal | author = Nilsson N, Christensen H, Hartvigsen J | title = Lasting changes in passive range motion after spinal manipulation: a randomized, blind, controlled trial. | journal = J Manipulative Physiol Ther | volume = 19 | issue = 3 | pages = 165–8 | year = 1996| pmid = 8728459}}</ref> | ||
| * Physiological effects on the central nervous system, probably at the segmental level<ref name="Murphy">{{cite journal |author=Murphy BA, Dawson NJ, Slack JR |title=Sacroiliac joint manipulation decreases the H-reflex |journal=Electromyogr Clin Neurophysiol |volume=35 |issue=2 |pages=87–94 |year=1995 |month=March |pmid=7781578 |doi= |url=}}</ref> | * Physiological effects on the central nervous system, probably at the segmental level<ref name="Murphy">{{cite journal |author=Murphy BA, Dawson NJ, Slack JR |title=Sacroiliac joint manipulation decreases the H-reflex |journal=Electromyogr Clin Neurophysiol |volume=35 |issue=2 |pages=87–94 |year=1995 |month=March |pmid=7781578 |doi= |url=}}</ref> | ||
| * Altered sensorimotor integration<ref></ref> | * Altered sensorimotor integration<ref></ref> | ||
| * No alteration of the position of the sacroiliac joint<ref name="Tullberg">{{cite journal |author=Tullberg T, Blomberg S, Branth B, Johnsson R |title=Manipulation does not alter the position of the sacroiliac joint. A roentgen stereophotogrammetric analysis |journal=Spine |volume=23 |issue=10 |pages=1124–8; discussion 1129 |year=1998 |month=May |pmid=9615363 |doi= 10.1097/00007632-199805150-00010|url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0362-2436&volume=23&issue=10&spage=1124 |quote=Because the supposed positive effects are not a result of a reduction of subluxation, further studies of the effects of manipulation should focus on the soft tissue response.}}</ref> | |||
| Common ]s of spinal manipulation are characterized as mild to moderate and may include: local discomfort, headache, tiredness, or radiating discomfort.<ref>{{cite journal |author=Senstad O, Leboeuf-Yde C, Borchgrevink C |title=Frequency and characteristics of side effects of spinal manipulative therapy (Adverse) |journal=Spine |volume=22 |issue=4 |pages=435–40; discussion 440–1 |year=1997 |month=February |pmid=9055373 |doi= 10.1097/00007632-199702150-00017|url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0362-2436&volume=22&issue=4&spage=435}}</ref> | |||
| == Effectiveness == | |||
| === Back pain === | |||
| A 2004 ] found that spinal manipulation (SM) was no more or less effective than other commonly used therapies such as ], ], exercises, back school or the care given by a general practitioner.<ref name=Cochrane04>{{cite journal |author=Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG |title=Spinal manipulative therapy for low back pain |journal=Cochrane Database Syst Rev |volume= |issue=1 |pages=CD000447 |year=2004 |pmid=14973958 |doi=10.1002/14651858.CD000447.pub2 |url= |editor1-last=Assendelft |editor1-first=Willem JJ}}</ref> A 2010 systematic review found that most studies suggest SM achieves equal or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up.<ref name=Dagenais>{{cite journal |journal= Spine J |year=2010 |volume=10 |issue=10 |pages=918–940 |title= NASS Contemporary Concepts in Spine Care: Spinal manipulation therapy for acute low back pain |author= Dagenais S, Gay RE, Tricco AC, Freeman MD, Mayer JM |pmid=20869008 |doi=10.1016/j.spinee.2010.07.389}}</ref> In 2007 the ] and the ] jointly recommended that clinicians consider spinal manipulation for patients who do not improve with self care options.<ref>{{cite journal |journal= Ann Intern Med |date= October 2, 2007 |volume=147 |issue=7 |pages=478–91 |title= Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society |author= Chou R |pmid=17909209 |url=http://annals.org/cgi/content/full/147/7/478 |author-separator= , |author2= Qaseem A |author3= Snow V |display-authors= 3 |last4= Casey |first4= D |last5= Cross Jr |first5= JT |last6= Shekelle |first6= P |last7= Owens |first7= DK |author8= Clinical Efficacy Assessment Subcommittee of the American College of Physicians |last9= American College Of |first9= Physicians |doi=10.7326/0003-4819-147-7-200710020-00006}}</ref> Reviews published in 2008 and 2006 suggested that SM for low back pain was equally effective as other commonly used interventions.<ref name=Murphy>{{cite journal |journal= J Manipulative Physiol Ther |year=2006 |volume=29 |issue=7 |pages=576–81, 581.e1–2 |title= Inconsistent grading of evidence across countries: a review of low back pain guidelines |author= Murphy AYMT, van Teijlingen ER, Gobbi MO |doi=10.1016/j.jmpt.2006.07.005 |pmid=16949948 |url=http://jmptonline.org/article/S0161-4754(06)00186-2/fulltext}}</ref><ref name=Bronfort-2008>{{cite journal |journal= ] |year=2008 |volume=8 |issue=1 |pages=213–25 |title= Evidence-informed management of chronic low back pain with spinal manipulation and mobilization |author= Bronfort G, Haas M, Evans R, Kawchuk G, Dagenais S |doi=10.1016/j.spinee.2007.10.023 |pmid=18164469}}</ref> A 2007 literature synthesis found good evidence supporting SM and mobilization for low back pain.<ref name=Meeker-2007>{{cite web |title= Chiropractic management of low back pain and low back related leg complaints |author= Meeker W, Branson R, Bronfort G ''et al.'' |url=http://ccgpp.org/lowbackliterature.pdf |format=PDF |year=2007 |accessdate=2008-03-13 |publisher= ]}}</ref> Of four systematic reviews published between 2000 and 2005, one recommended SM and three stated that there was insufficient evidence to make recommendations.<ref>{{cite journal |journal= J R Soc Med |year=2006 |volume=99 |issue=4 |pages=192–6 |title= A systematic review of systematic reviews of spinal manipulation |author= Ernst E, Canter PH |doi=10.1258/jrsm.99.4.192 |pmid=16574972 |url=http://www.jrsm.org/cgi/content/full/99/4/192 |laysummary=http://news.bbc.co.uk/2/hi/health/4824594.stm |laysource= BBC News |laydate=2006-03-22 |pmc= 1420782}}</ref> | |||
| === Neck pain === | |||
| For neck pain manipulation and mobilization produce similar changes, and manual therapy and exercise are more effective than other strategies.<ref>{{cite journal |author=Gross A |title=Manipulation or mobilisation for neck pain |journal=Cochrane Database Syst Rev |volume= |issue=1 |pages=CD004249 |year=2010 |pmid=20091561 |doi=10.1002/14651858.CD004249.pub3 |url= |author-separator=, |author2=Miller J |author3=D'Sylva J |display-authors=3 |last4=Burnie |first4=Stephen J |last5=Goldsmith |first5=Charles H |last6=Graham |first6=Nadine |last7=Haines |first7=Ted |last8=Brønfort |first8=Gert |last9=Hoving |first9=Jan L |editor1-last=Gross |editor1-first=Anita}}</ref><ref>{{cite journal |author=Hurwitz EL |title=Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders |journal=Spine |volume=33 |issue=4 Suppl |pages=S123–52 |year=2008 |month=February |pmid=18204386 |doi=10.1097/BRS.0b013e3181644b1d |url= |author-separator=, |author2=Carragee EJ |author3=van der Velde G |display-authors=3 |last4=Carroll |first4=Linda J. |last5=Nordin |first5=Margareta |last6=Guzman |first6=Jaime |last7=Peloso |first7=Paul M. |last8=Holm |first8=Lena W. |last9=Côté |first9=Pierre }}</ref> | |||
| There is moderate- to high-quality evidence that subjects with chronic neck pain not due to ] and without arm pain and headaches show clinically important improvements from a course of spinal manipulation or mobilization.<ref>{{cite journal |author=Vernon H, Humphreys K, Hagino C |title=Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials |journal=J Manipulative Physiol Ther |volume=30 |issue=3 |pages=215–27 |year=2007 |pmid=17416276 |doi=10.1016/j.jmpt.2007.01.014 |url=}}</ref> There is not enough evidence to suggest that spinal manipulation is an effective long-term treatment for whiplash although there are short term benefits.<ref>{{cite journal |author=Martín Saborido C, García Lizana F, Alcázar Alcázar R, Sarría-Santamera A |title= |language=Spanish; Castilian |journal=Aten Primaria |volume=39 |issue=5 |pages=241–6 |year=2007 |month=May |pmid=17493449 |doi= |url=http://db.doyma.es/cgi-bin/wdbcgi.exe/doyma/mrevista.pubmed_full?inctrl=05ZI0105&rev=27&vol=39&num=5&pag=241}}</ref> | |||
| === Non-musculoskeletal === | |||
| There was some evidence that spinal manipulation improved psychological outcomes compared with verbal interventions.<ref>{{cite journal |author=Williams NH, Hendry M, Lewis R, Russell I, Westmoreland A, Wilkinson C |title=Psychological response in spinal manipulation (PRISM): a systematic review of psychological outcomes in randomised controlled trials |journal=Complement Ther Med |volume=15 |issue=4 |pages=271–83 |year=2007 |month=December |pmid=18054729 |doi=10.1016/j.ctim.2007.01.008 |url=}}</ref> | |||
| == Safety == | == Safety == | ||
| The safe application of spinal manipulation requires a thorough medical history, assessment, diagnosis and plan of management. Manipulative therapists, including chiropractors, must rule out ] to HVLA spinal manipulative techniques. Absolute contraindications refers to diagnoses and conditions that put the patient at risk to developing ]. For example, a diagnosis of ] and other conditions that structurally destabilizes joints, is an absolute contraindication of SMT to the upper cervical spine. Relative contraindications, such as ] are conditions where increased risk is acceptable in some situations and where mobilization and ] techniques would be treatments of choice. Most contraindication apply only to the manipulation of the affected region.<ref name=CCA-CFCREAB-CPG>{{cite journal|journal=J Can Chiropr Assoc|year=2005|volume=49|issue=3|pages=158–209|title= Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash|author= Anderson-Peacock E, Blouin JS, Bryans R ''et al.''|url=http://jcca-online.org/ecms.ashx/PDF/2005/2005-3/Chiropracticclinicalpracticeguideline-evidence-basedtreatmentofadultneckpainnotduetowhiplash.pdf|format=PDF|pmid=17549134|pmc=1839918 }}<br/>• {{cite journal|journal=J Can Chiropr Assoc|year=2008|volume=52|issue=1|pages=7–8|title=A Clinical Practice Guideline Update from The CCA•CFCREAB-CPG|author= Anderson-Peacock E, Bryans B, Descarreaux M ''et al.''|url=http://jcca-online.org/ecms.ashx/PDF/2008/2008-1/ClinicalPracticeGuidelineUpdatefromTheCCACFCREABCPG.pdf|format=PDF|pmid=18327295|pmc=2258235 }}</ref> | |||
| {{see also|Spinal adjustment#Safety}} | |||
| Adverse events in SM studies are believed to be under-reported <ref name=Ernst-2012>{{cite journal|journal=N Z Med J|year=2012|volume=125|issue=1353|pages=87–140|title= Reporting of adverse effects in randomised clinical trials of chiropractic manipulations: a systematic review|author= Ernst E, Posadzki P|pmid=22522273|url=|pmc=}}</ref> and appear to be more common following HVLA manipulation than mobilization.<ref>{{cite journal|author=Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM|title=Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study|journal=]|volume=30|issue=13|pages=1477–84|year=2005|month=July|pmid=15990659|doi= 10.1097/01.brs.0000167821.39373.c1|url=}}</ref> | |||
| As with all interventions, there are risks associated with spinal manipulation. Infrequent, but potentially serious side effects, include: vertebrobasilar accidents (VBA), ]s, ], ], ] and ] ]s, and ].<ref> ''Spine.'' 22(4) 435-440, February 15, 1997.</ref> | |||
| Mild, frequent and temporary adverse events occur in SMT which include temporary increase in pain, tenderness and stiffness.<ref name=Ernst-adverse/> These events typically dissipates within 24-48 hours <ref name=Gouveia>{{cite journal|author= Gouveia LO, Castanho P, Ferreira JJ|title= Safety of chiropractic interventions: a systematic review|journal=Spine|volume=34|issue=11|pages=E405–13|year=2009|pmid=19444054|doi=10.1097/BRS.0b013e3181a16d63}}</ref> Serious injuries and fatal consequences , especially to SM in the upper cervical region, can occur.<ref>{{cite journal|journal=Spine|year=2007|volume=32|issue=21|pages=2375–8|title= Safety of chiropractic manipulation of the cervical spine: a prospective national survey|author= Thiel HW, Bolton JE, Docherty S, Portlock JC|doi=10.1097/BRS.0b013e3181557bb1|pmid=17906581}}</ref> but are regarded as rare when spinal manipulation is employed skillfully and appropriately.<ref name=CCA-CFCREAB-CPG>{{cite journal|journal=J Can Chiropr Assoc|year=2005|volume=49|issue=3|pages=158–209|title= Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash|author= Anderson-Peacock E, Blouin JS, Bryans R ''et al.''|url=http://jcca-online.org/ecms.ashx/PDF/2005/2005-3/Chiropracticclinicalpracticeguideline-evidence-basedtreatmentofadultneckpainnotduetowhiplash.pdf|format=PDF|pmid=17549134|pmc=1839918 }}<br/>• {{cite journal|journal=J Can Chiropr Assoc|year=2008|volume=52|issue=1|pages=7–8|title=A Clinical Practice Guideline Update from The CCA•CFCREAB-CPG|author= Anderson-Peacock E, Bryans B, Descarreaux M ''et al.''|url=http://jcca-online.org/ecms.ashx/PDF/2008/2008-1/ClinicalPracticeGuidelineUpdatefromTheCCACFCREABCPG.pdf|format=PDF|pmid=18327295|pmc=2258235 }}</ref> | |||
| There is considerable debate regarding the relationship of spinal manipulation to the upper cervical spine and ]. Stoke is ] with both general practitioner and chiropractic services in persons under 45 years of age suggesting that these associations are likely explained by preexisting conditions.<ref name=Hurwitz-2008>{{cite journal|journal=Spine|year=2008|volume=33|issue= 4 Suppl|pages=S123–52|title= Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders|author= Hurwitz EL, Carragee EJ, van der Velde G ''et al.''|doi=10.1097/BRS.0b013e3181644b1d|pmid=18204386}}</ref><ref>{{cite journal|author= Paciaroni M, Bogousslavsky J|title= Cerebrovascular complications of neck manipulation|journal= Eur Neurol|volume=61|issue=2|pages=112–8|year=2009|pmid=19065058|doi=10.1159/000180314|url=http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowFulltext&ArtikelNr=180314&ProduktNr=223840}}</ref><ref>{{cite journal|last=Cassidy|first=JD|coauthors=Boyle, E; Côté, P; He, Y; Hogg-Johnson, S; Silver, FL; Bondy, SJ|title=Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study.|journal=Spine|date=15|year=2008|month=Feb|volume=33|issue=4 Suppl|pages=S176-83|pmid=18204390|accessdate=2 December 2012}} </ref>Weak to moderately strong evidence supports causation (as opposed to statistical association) between ] and vertebrobasilar artery stroke.<ref>{{cite journal|journal=]|year=2008|volume=14|issue=1|pages=66–73|title= Does cervical manipulative therapy cause vertebral artery dissection and stroke?|author= Miley ML, Wellik KE, Wingerchuk DM, Demaerschalk BM|doi=10.1097/NRL.0b013e318164e53d|pmid=18195663}}</ref> A 2012 systematic review determined that there is insufficient evidence to support a strong association or no association between cervical manipulation and stroke.<ref name=Haynes>{{cite journal|journal=International Journal of Clinical Practice|year=2012|volume=66|issue=10|pages=940–947|title= Assessing the risk of stroke from neck manipulation: a systematic review|author= Haynes MJ, Vincent K, Fischhoff C, Bremner AP, Lanlo O, Hankey GJ.|doi=10.1111/j.1742-1241.2012.03004.x|pmid=22994328|url=http://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2012.03004.x/full}}</ref> | |||
| In a 1993 study, J.D. Cassidy, DC, and co-workers concluded that the treatment of lumbar intervertebral disk herniation by side posture manipulation is "both safe and effective."<ref>{{cite journal | author = Cassidy JD, Thiel H, Kirkaldy-Willis W | title = Side posture manipulation for lumbar intervertebral disk herniation | journal = J Manip Physiol Ther | volume = 16 | pages = 96–103 | year = 1993 | pmid = 8445360 | issue = 2}}</ref> | |||
| === Risks of upper cervical manipulation === | |||
| The degree of serious ]s associated with ] is uncertain, with widely differing results being published. | |||
| A 1996 Danish chiropractic study confirmed the risk of stroke to be low, and determined that the greatest risk is with manipulation of the first two vertebra of the cervical spine, particularly passive ] of the neck, known as the "master cervical" or "rotary break."<ref>{{cite journal | author = Klougart N, Leboeuf-Yde C, Rasmussen L | title = Safety in chiropractic practice, Part I; The occurrence of cerebrovascular accidents after manipulation to the neck in Denmark from 1978-1988 | journal = J Manip Physiol Ther | volume = 19 | pages = 371–7 | year = 1996| pmid = 8864967 | issue = 6}}</ref> | |||
| Serious complications after manipulation of the cervical spine are estimated to be 1 in 4 million manipulations or fewer.<ref>Lauretti W "What are the risk of chiropractic neck treatments?" retrieved online 08 028 2006 from </ref> A ] Corporation extensive review estimated "one in a million."<ref name="Coulter">Coulter ID, Hurwitz EL, Adams AH, ''et al.'' (1996) The appropriateness of manipulation and mobilization of the cervical spine 'Santa Monica, CA, Rand Corp: xiv . Current </ref> Dvorak, in a survey of 203 practitioners of manual medicine in Switzerland, found a rate of one serious complication per 400,000 cervical manipulations, without any reported deaths, among an estimated 1.5 million cervical manipulations.<ref>Dvorak J, Orelli F. ''How dangerous is manipulation to the cervical spine?'' Manual Medicine 1985; 2: 1-4.</ref> Jaskoviak reported approximately 5 million cervical manipulations from 1965 to 1980 at The National College of Chiropractic Clinic in Chicago, without a single case of vertebral artery stroke or serious injury.<ref>Jaskoviak P. ''Complications arising from manipulation of the cervical spine''. J Manip Physiol Ther 1980; 3: 213-19.</ref> Henderson and Cassidy performed a survey at the Canadian Memorial Chiropractic College outpatient clinic where more than a half-million treatments were given over a nine-year period, again without serious incident.<ref>Henderson DJ, Cassidy JD. Vertebral Artery syndrome. In: Vernon H. ''Upper cervical syndrome: chiropractic diagnosis and treatment''. Baltimore: Williams and Wilkins, 1988: 195-222.</ref> Eder offered a report of 168,000 cervical manipulations over a 28 year period, again without a single significant complication.<ref>Eder M, Tilscher H. ''Chiropractic therapy: diagnosis and treatment'' (English translation). Rockville, Md: Aspen Publishers, 1990: 61.</ref> After an extensive literature review performed to formulate practice guidelines, the authors concurred that "the risk of serious neurological complications (from cervical manipulation) is extremely low, and is approximately one or two per million cervical manipulations."<ref>Haldeman S, Chapman-Smith D, Petersen DM. ''Guidelines for chiropractic quality assurance and practice parameters.'' Gaithersburg, Md: Aspen Publishers, 1993: 170-2.</ref> | |||
| Understandably, vascular accidents are responsible for the major criticism of spinal manipulative therapy. However, it has been pointed out that "critics of manipulative therapy emphasize the possibility of serious injury, especially at the brain stem, due to arterial trauma after cervical manipulation. It has required only the very rare reporting of these accidents to malign a therapeutic procedure that, in experienced hands, gives beneficial results with few adverse side effects".<ref>Kleynhans AM, Terrett AG. Cerebrovascular complications of manipulation. In: Haldeman S, ed. ''Principles and practice of chiropractic'', 2nd ed. East Norwalk, CT, Appleton Lang, 1992.</ref> In very rare instances, the manipulative adjustment to the cervical spine of a vulnerable patient becomes the final intrusive act which results in a very serious consequence.<ref>Haldeman S, Kohlbeck F, McGregor M. ''Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty‐four cases after cervical spine manipulation''" ''Spine'' 2002, 27(1) 49‐55.</ref><ref>Rothwell D, Bondy S, Williams J. ''Chiropractic manipulation and stroke: a population-based case‐controlled study''" ''Stroke'' 2001, 32:1054‐60.</ref><ref>Haldeman, S ''et al.'' ''Clinical perceptions of the risk of vertebral artery dissection after cervical manipulation: the effect of referral bias''" ''Spine'' 2002, 2(5) 334‐342.</ref><ref>Haldeman S ''et al.'' ''Arterial dissections following cervical manipulation: the chiropractic experience''. Journal of the Canadian Medical Association, 2001, 2, 165(7) 905‐906.</ref> | |||
| ] has written: | |||
| :"...there is little evidence to demonstrate that spinal manipulation has any specific therapeutic effects. On the other hand, there is convincing evidence to show that it is associated with frequent, mild ] as well as with serious complications of unknown incidence. Therefore, it seems debatable whether the benefits of spinal manipulation outweigh its risks. Specific risk factors for vascular accidents related to spinal manipulation have not been identified, which means that any patient may be at risk, particularly those below 45 years of age. Definitive, prospective studies that can overcome the limitations of previous investigations are now a matter of urgency. Until they are available, clinicians might tell their patients to adopt a cautious approach and avoid the type of spinal manipulation for which the risk seems greatest: forceful manipulation of the upper spine with a rotational element."<ref name="ernst_safety"/> | |||
| In a 2007 followup report in the Journal of the Royal Society of Medicine, Ernst concluded: "Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation."<ref></ref> | |||
| === Potential for incident underreporting === | |||
| Statistics on the reliability of incident reporting for injuries related to manipulation of the cervical spine vary. The ] study assumed that only 1 in 10 cases would have been reported. However, ] surveyed neurologists in Britain for cases of serious neurological complications occurring within 24 hours of cervical spinal manipulation by various types of practitioners; 35 cases had been seen by the 24 neurologists who responded, but none of the cases had been reported. He concluded that underreporting was close to 100%, rendering estimates "nonsensical." He therefore suggested that ''"clinicians might tell their patients to adopt a cautious approach and avoid the type of spinal manipulation for which the risk seems greatest: forceful manipulation of the upper spine with a rotational element."''<ref name="ernst_safety">. Edzard Ernst, ''CMAJ'', January 8, 2002; 166 (1)</ref> The NHS Centre for Reviews and Dissemination stated that the survey had methodological problems with data collection.<ref name = "NHS Chiro Maim"></ref> Both NHS and Ernst noted that bias is a problem with the survey method of data collection. | |||
| A 2001 study in the journal ''Stroke'' found that vertebrobasilar accidents (VBAs) were five times more likely in those aged less than 45 years who had visited a chiropractor in the preceding week, compared to controls who had not visited a chiropractor. No significant associations were found for those over 45 years. The authors concluded: ''"While our analysis is consistent with a positive association in young adults... The rarity of VBAs makes this association difficult to study despite high volumes of chiropractic treatment."''<ref>{{cite journal | author = Rothwell D, Bondy S, Williams J | title = Chiropractic manipulation and stroke: a population-based case-control study | journal = Stroke | volume = 32 | pages = 1054–60 | year = 2001 | pmid = 11340209 | issue = 5 | doi = 10.1161/01.STR.32.5.1054}} Original </ref> The NHS notes that this study collected data objectively by using administrative data, involving less recall bias than survey studies, but the data were collected retrospectively and probably contained inaccuracies.<ref name = "NHS Chiro Maim"/> | |||
| In 1996, Coulter ''et al.''<ref name ="Coulter"/> had a multidisciplinary group of 4 MDs, 4 DCs and 1 MD/DC look at 736 conditions where it was used. Their job was to evaluate the appropriateness of manipulation or mobilization of the cervical spine in those cases (including a few cases not performed by chiropractors). | |||
| : "According to the report ... 57.6% of reported indications for cervical manipulation was considered inappropriate, with 31.3% uncertain. Only 11.1% could be labeled appropriate. A panel of chiropractors and medical practitioners concluded that '. . . much additional scientific data about the efficacy of cervical spine manipulation are needed.'"<ref name="Finding"> Samuel Homola, DC. ''Arch Fam Med.'' 1998;7:20-23.</ref> | |||
| === Misattribution problems === | |||
| Studies of stroke and manipulation do not always clearly identify what professional has performed the manipulation. In some cases this has led to confusion and improper placement of blame. In a 1995 study, chiropractic researcher Allan Terrett, DC, pointed to this problem: | |||
| :"The words chiropractic and chiropractor have been incorrectly used in numerous publications dealing with SMT injury by medical authors, respected medical journals and medical organizations. In many cases, this is not accidental; the authors had access to original reports that identified the practitioner involved as a nonchiropractor. The true incidence of such reporting cannot be determined. Such reporting adversely affects the reader's opinion of chiropractic and chiropractors."<ref name="Terrett">{{cite journal | author = Terrett A | title = Misuse of the literature by medical authors in discussing spinal manipulative therapy injury | journal = J Manipulative Physiol Ther | volume = 18 | issue = 4 | pages = 203–10 | year = 1995 | pmid = 7636409}}</ref> | |||
| This error was taken into account in a 1999 review<ref name="Di Fabio">{{cite journal | author = Di Fabio R | title = Manipulation of the cervical spine: risks and benefits | journal = Phys Ther | volume = 79 | issue = 1 | pages = 50–65 | year = 1999 | pmid = 9920191 | url = http://ptjournal.apta.org/content/79/1/50.full | accessdate=2011-11-24}}</ref> of the scientific literature on the risks and benefits of manipulation of the cervical spine (MCS). Special care was taken, whenever possible, to correctly identify all the professions involved, as well as the type of manipulation responsible for any injuries and/or deaths. It analyzed 177 cases that were reported in 116 articles published between 1925 and 1997, and summarized: | |||
| : "The most frequently reported injuries involved arterial dissection or spasm, and lesions of the brain stem. Death occurred in 32 (18%) of the cases. Physical therapists were involved in less than 2% of the cases, and no deaths have been attributed to MCS provided by physical therapists. Although the risk of injury associated with MCS appears to be small, this type of therapy has the potential to expose patients to vertebral artery damage that can be avoided with the use of mobilization (nonthrust passive movements)."<ref name="Di Fabio"/> | |||
| In Figure 1 in the review, the types of injuries attributed to manipulation of the cervical spine are shown,<ref></ref> and Figure 2 shows the type of practitioner involved in the resulting injury.<ref></ref> For the purpose of comparison, the type of practitioner was adjusted according to the findings by Terrett.<ref name="Terrett"/> | |||
| The review concluded: | |||
| : "The literature does not demonstrate that the benefits of MCS outweigh the risks. Several recommendations for future studies and for the practice of MCS are discussed."<ref name="Di Fabio"/> | |||
| == Emergency medicine == | |||
| In ] joint manipulation can also refer to the process of bringing fragments of ] bone or ] joints into normal ] alignment (otherwise known as 'reducing' the fracture or dislocation). These procedures have no relation to the HVLA thrust procedure. | |||
| == See also == | == See also == | ||
| * ] | |||
| * ] | * ] | ||
| * ] | * ] | ||
| * ] | * ] | ||
| == References == | == References == | ||
| {{reflist}} | {{reflist}} | ||
| == Further reading == | |||
| * Cyriax, J. ''Textbook of Orthopaedic Medicine, Vol. I: Diagnosis of Soft Tissue Lesions'' 8th ed. Bailliere Tindall, London, 1982. | |||
| * Cyriax, J. ''Textbook of Orthopaedic Medicine, Vol. II: Treatment by Manipulation, Massage and Injection'' 10th ed. Bailliere Tindall, London, 1983. | |||
| * Greive ''Modern Manual Therapy of the Vertebral Column.'' Harcourt Publishers Ltd., 1994 | |||
| * Maitland, G.D. ''Peripheral Manipulation'' 2nd ed. Butterworths, London, 1977. | |||
| * Maitland, G.D. ''Vertebral Manipulation'' 5th ed. Butterworths, London, 1986. | |||
| * McKenzie, R.A. ''The Lumbar Spine; Mechanical Diagnosis and Therapy.'' Spinal Publications, Waikanae, New Zealand, 1981. | |||
| * McKenzie, R.A. ''The Cervical and Thoracic Spine; Mechanical Diagnosis and Therapy.'' Spinal Publications, Waikanae, New Zealand, 1990. | |||
| * Mennel, J.M. ''Joint Pain; Diagnosis and Treatment Using Manipulative Techniques.'' Little Brown and Co., Boston, 1964. | |||
| == External links == | |||
| * | |||
| * | |||
| * | |||
| * | |||
| * | |||
| * : recommendations of the French Society of Orthopaedic and Osteopathic Manual Medicine (SOFMMOO).<!-- They were published in English in: Vautravers P, Maigne JY. Cervical spine manipulation and the precautionary principle. Joint Bone Spine. 2000;67:272-6. --> | |||
| * | |||
| ] | ] | ||
| ] | ] | ||
| ] | ] | ||
| ] | ] | ||
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Revision as of 17:49, 17 February 2013
For detail of manipulation in individual synovial joints, see Joint manipulation.
Spinal manipulation is a therapeutic intervention used to treatment dysfunctional joints in the hopes of reducing pain and disability of the neuromusculoskeletal system. The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "father of medicine" used manipulative techniques, as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine. SMT gained mainstream recognition during the 1980s. Spinal manipulation/adjustment describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues. It is the most common and primary intervention used in chiropractic care. In North America, chiropractors perform over 90% of all manipulative treatments with the balance provided by osteopathic medicine, physical therapy and naturopathic medicine. Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia. Typically, it is performed on patients who have failed to respond to other forms of treatment.There has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine. Although serious injuries and fatal consequences can occur and are likely to be under-reported, these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.
Research
In 1975, legitimate scientific investigation from the chiropractic, osteopathic and allopathic communities were invited to attended the first research symposium on spinal manipulation at the National Institute of Health (NIH.) Basic science studies presented were in anatomy, biochemistry, biomechanics, and neuroscience. Clinical investigators with chiropractic, osteopathic and medical backgrounds presented papers on research findings from pathology, radiology and clinical evaluations; the latter being primarily observational studies. In the 1980s, spinal manipulation had gained mainstream acceptance,which has led to increased collaboration with medical practitioners on models for the delivery manual and manipulative therapies for spinal and musculoskeletal conditions.
Terminology
High-velocity low amplitude {HVLA) manipulative therapy is also known as adjustment and Grade V mobilisation. Chiropractors and some osteopaths prefer to use the term "adjustment," a term which reflects "their belief in the therapeutic and health-enhancing effect of correcting spinal joint abnormalities."
Manual and manipulative therapy
The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "father of medicine" used manipulative techniques, as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine. SMT gained mainstream recognition during the 1980s. Spinal manipulation/adjustment describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues. It is the most common and primary intervention used in chiropractic care; In North America, chiropractors perform over 90% of all manipulative treatments with the balance provided by the osteopathic medicine, physical therapy professions. Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia. Typically, it is performed on patients who have failed to respond to other forms of treatment.There has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine. Although serious injuries and fatal consequences can occur and may be under-reported, these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately. Manual and manipulative techniques can be categorized by different modes depending on therapeutic intent, indications, contraindications and safety. Manual and mechanically assisted manipulative procedures can include:
- HVLA thrust manipulation
- HVLA thrust manipulation with recoil
- LVLA manipulation (mobilization)
- Drop tables and terminal point manipulative thrust
- Flexion-distraction and traction-type tables
- Pelvic blocks
- Instrument assisted manipulative devices
Manual non-articular manipulative procedures can include:
- Manual reflex and muscle relaxation procedures
- Muscle energy techniques
- Reflex techniques
- Myofascial ischemic compression procedures
- Myofascial, and soft tissue manipulative techniques
Scientific investigation
Musculoskeletal disorders
The use of manual and manipulative therapies is a commonly used intervention used by manual medicine practitioners in the treatment of neuromusculoskeletal disorders. Spinal manipulation, in particular is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain Manual therapies, including spinal manipulation, commonly used by chiropractors and other manual medicine practitioners are effective for the treatment of spinal pain, including low back pain, neck pain, some forms of headache and a number of extremity joint conditions such as shoulder and hip pain. Specifically, spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck painand might also be effective for the treatment of lumbar disc herniation with radiculopathy, neck pain, some forms of headache, and some extremity joint conditions. Investigation of the effectiveness of spinal manipulation for specific musculoskeletal complaints include:
- Low back pain. Most studies suggest spinal manipulation achieves equivalent or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up. A 2008 review found strong evidence that SM is similar in effect to medical care with exercise. A 2008 literature synthesis found good evidence supporting SM for low back pain regardless of duration. The American College of Physicians and the American Pain Society jointly recommended that clinicians consider spinal manipulation for patients who do not improve with self care options.
- Radiculopathy. There is moderate quality evidence to support the use of spinal manipulation for the treatment of acute lumbar radiculopathy and acute lumbar disc herniation with associated radiculopathy. The evidence for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration is low or very low and no evidence exists for the treatment of thoracic radiculopathy.
- Neck pain. Manual therapies, including spinal manipulation, has been found to be effective for mechanical neck pain. Thoracic spinal manipulation (TSM) has a therapeutic benefit to some patients with neck pain and therefore TSM or in combination with other interventions is a suitable intervention to use in the treatment of non-specific neck pain.
- Headache Spinal manipulation, improves migraine and cervicogenic headaches but cautioned type, frequency, dosage, and duration of treatments should be based on guideline recommendations, clinical experience, and findings. Evidence for the use of spinal manipulation as an isolated intervention for patients with tension-type headache remains equivocal. SM might be as effective as propranolol or topiramate in the prevention of migraine headaches,
- Cervicogenic dizziness There is moderate evidence to support the use of manual therapy for cervicogenic dizziness.
- Extremity conditions. Manual mobilizations to an exercise program for the treatment of knee osteoarthritis resulted in better pain relief then a supervised exercise program alone and suggested that manual therapists consider adding manual mobilisation to optimise supervised active exercise programs. There is silver level evidence that manual therapy is more effective than exercise for the treatment of hip osteoarthritis, however this evidence could be considered to be inconclusive. The addition of cervical spine mobilization to a treatment regimen for lateral epicondylosis (tennis elbow) result in significantly better pain relief and functional improvements in both the short and long-term. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs, limited to low level evidence supporting chiropractic management of shoulder pain and limited or fair evidence supporting chiropractic management of leg conditions.
Non-musculoskeletal
The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic. and no scientific data for idiopathic adolescent scoliosis.
Cost-effectiveness
Spinal manipulation used clinical practice can be cost-effective treatment when used alone or in combination with other treatment approaches. Evidence supporting the cost-effectiveness of using spinal manipulation for the treatment of sub-acute or chronic low back pain; the results for acute low back pain were inconsistent.
Biomechanics
The kinematics of a complete spinal motion segment, when one of its constituent spinal joints is manipulated, are much more complex than the kinematics that occur during manipulation of an independent peripheral synovial joint. Until recently, force-time histories measured during spinal manipulation were described as consisting of three distinct phases: the preload (or prethrust) phase, the thrust phase, and the resolution phase. Evans and Breen added a fourth ‘orientation’ phase to describe the period during which the patient is orientated into the appropriate position in preparation for the prethrust phase.
Effects
The neurophysiological effects of spinal manipulation have been shown to include:
- Temporary increase in passive range of motion (ROM)
- Physiological effects on the central nervous system, probably at the segmental level
- Altered sensorimotor integration
Safety
The safe application of spinal manipulation requires a thorough medical history, assessment, diagnosis and plan of management. Manipulative therapists, including chiropractors, must rule out contraindications to HVLA spinal manipulative techniques. Absolute contraindications refers to diagnoses and conditions that put the patient at risk to developing adverse events. For example, a diagnosis of rheumatoid arthritis and other conditions that structurally destabilizes joints, is an absolute contraindication of SMT to the upper cervical spine. Relative contraindications, such as osteoporosis are conditions where increased risk is acceptable in some situations and where mobilization and soft-tissue techniques would be treatments of choice. Most contraindication apply only to the manipulation of the affected region.
Adverse events in SM studies are believed to be under-reported and appear to be more common following HVLA manipulation than mobilization. Mild, frequent and temporary adverse events occur in SMT which include temporary increase in pain, tenderness and stiffness. These events typically dissipates within 24-48 hours Serious injuries and fatal consequences , especially to SM in the upper cervical region, can occur. but are regarded as rare when spinal manipulation is employed skillfully and appropriately.
There is considerable debate regarding the relationship of spinal manipulation to the upper cervical spine and stroke. Stoke is statistically associated with both general practitioner and chiropractic services in persons under 45 years of age suggesting that these associations are likely explained by preexisting conditions.Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke. A 2012 systematic review determined that there is insufficient evidence to support a strong association or no association between cervical manipulation and stroke.
See also
References
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