What is the real risk from a Cervical spine manipulation?
Manipulations are a technique used by Physio’s, Chiropractors, Osteopaths and amazingly I’ve seen them done by some foreign Barbers! Scary!!!
They can be done on most joints in the body, with the aim of
reducing pain and spasm along with improving movement and function. What they
don’t do is to ‘crack you back in place’. Read here for more information on
manipulation:
What is the risk?
The main risk is a stroke caused mostly by Vertebral artery
dissection but lesser complications can occur too. The risks are very low but
they do exist. Between 1925 & 1997 there were 177 cases of neck injury
associated with neck manipulation, at least 60% were done by chiropractors
(Fabio 1999). Considering the time frame this is a low rate but as you can see
there is a risk.
The most frequently reported injuries involved arterial
dissection, muscle spasm and lesions of the brain stem.
Death occurred in 32 of the 177!
YIKES!
Physiotherapists were involved in less than 2% of the cases,
with no deaths. This is likely related to the smaller volume of manipulations
done by Physiotherapists (Fabio 1999).
A study by Ernst (2007) looked at two prospective reports
suggesting that relatively mild adverse effects occur in 30% to 61% of all
patients following a spinal manipulation. Now that’s a pretty high percentage
but it is common to get some adverse effects from a lot of other treatments
too.
A study looking at patients who had a vertebral artery
dissection after receiving a Cervical manipulation found that after 4 weeks and
up to 3 years, 5 patients had no or mild neurological deficits, marked deficits
were still in 3 patients, there was persistent locked-in syndrome in 1 and a persistent
vegetative state in 1 (Hufnagel et al 1999).
In another study comparing stroke sufferers to non-stroke
sufferers it was found that in the under 45 year old age category, the stroke
sufferer group were 5 times more likely to have had a Cervical manipulation in
the week before the stroke occurred when compared to a non-stroke control group
(Rothwell et al 2001).
Now there is always two sides to an argument:
Haynes et al (2012) found that conclusive evidence is
lacking for the association between neck manipulation & stroke.
Cervical manipulation safety is still not clear although it does reduce pain in Cervical Radiculopathy (Wei & Wang 2015).
Cervical manipulation safety is still not clear although it does reduce pain in Cervical Radiculopathy (Wei & Wang 2015).
There is an argument that it is more about the person doing
the technique than the technique itself. For example Melikyan et al (2016)
found that Cervical manipulation can result in catastrophic vascular lesions,
preventable, if these practices are limited to highly specialised personnel
under very specific situations. So the risk is there just like it is with
having surgery but if the person is correctly trained and assesses the patient
for appropriateness then it is safe.
Another major flaw with the ‘danger’ of manipulation is that
Stroke has been reported by people following yoga, just looking up and even hair
washing at a hair salon (Cassidy et al 2012).
So what do I personally think?
I believe that done correctly on the correct patient then
the risk exists but is low. The reality is likely that they were going to
stroke just looking up even if you hadn’t manipulated them. However this being
said, I wouldn’t like to think that I caused it or could cause it. The bigger argument
for me, is that I can achieve similar results from other techniques and so
maybe it is best to play it safe. This is why I haven’t done a Cervical spine a
manipulation in many years now.
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