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Is Spine Manipulation for Neck Pain Safe?

A common chiropractic treatment for neck pain is “inadvisable” due to a risk of stroke, and should be avoided, say experts.

A new review in the British Medical Journal warns against the use of cervical spine manipulation for neck pain. This common chiropractic treatment, which involves high-speed thrusts to the neck, carries a low risk of stroke resulting from damage to arteries in the neck. After looking at evidence from previous studies, Neil O'Connell and colleagues concluded that the technique is "unnecessary and inadvisable.”

Other experts, writing in the same edition of the BMJ, however, say that manipulation of the cervical spine is a useful tool for treatment of neck pain. In addition to treating neck pain, this technique is used by chiropractors, physiotherapists and osteopaths to alleviate back pain and other conditions of the musculoskeletal system.

While the risk of stroke or tearing of arteries that supply blood to the brain is low, some studies show that cervical spine manipulation provides only short-term relief. As a result, O'Connell and colleagues conclude that: "The potential for catastrophic events and the clear absence of unique benefit lead to the inevitable conclusion that manipulation of the cervical spine should be abandoned as part of conservative care for neck pain."

In the opposing article, David Cassidy and colleagues say it is too early to abandon the technique. Their review of the evidence "clearly suggests that manipulation benefits patients with neck pain.” They also called for more research to determine which treatments are effective and safe.

While the debate is unlikely to be settled soon, some doctors advise patients to undergo a full physical exam before receiving cervical spine manipulation. This would identify underlying problems—such as a herniated disc—and allow them to first try other types of treatment to relieve the pain.

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