More adverse symptoms with chiropractic neck manipulation compared to mobilisation

A new study (Spine. 2005;30:1477-1484) is the first randomised trial to study adverse effects of chiropractic manipulation compared to mobilisation.

The authors note that “observational studies have shown that within hours after treatment, nearly a third to a half of chiropractic patients have transient unpleasant reactions such as discomfort, increased pain or stiffness, radiating symptoms, headache, and tiredness.”

Manipulation was described as “at least one controlled dynamic thrust, applied with high velocity and low amplitude force”. This is a vigorous manoeuvre and produces the characteristic cracking sound. Mobilisation involved “one or more movements of low velocity and variable amplitude directed to one or more restricted upper thoracic and/or cervical spine joint segments”. This is more like firm rhythmic pushing on the joints and is a much gentler technique.

In the manipulation group there were 44% more adverse events than in the mobilisation group. Given that both types of treatment have similar efficacy we should be cautious about recommending manipulation over mobilisation for treatment of neck conditions.

Contact Dr David Allen on 98977699 or david allen@qoh.com.au for more information.