`Spine manipulation for neck pain inadvisable`

London: Chiropractic treatment for neck pain, a common technique which involves applying thrusts to the neck area of the spine, should be abandoned as it carries a low risk of stroke, scientists have claimed.

Writing in the British Medical Journal, Neil O`Connell and colleagues from the Centre for Research and Rehabilitation at Brunel University said cervical spine manipulation may cause damage to the key neck arteries and lead to a stroke.

The technique is "unnecessary and inadvisable", they said.

But other experts believe the technique used to treat neck and back pain or other musculoskeletal conditions is a valuable addition to patient care, the BBC reported.

Cervical spine manipulation, used by physiotherapists, osteopaths and most commonly chiropractors, focuses on the neck and involves a range of high-speed manual manoeuvres that stretch, mobilise or manipulate the upper spine in order to relieve pain.

But the technique "may carry the potential for serious neurovascular complications", O`Connell and colleagues argued.

They also said that studies "provide consistent evidence of an association between neurovascular injury and recent exposure to cervical manipulation."

Such injuries include tearing the lining of the vertebral artery, which is located in the neck and supplies blood to the brain, and stroke, they claimed.
The researchers refereed to a review of randomised trials of neck manipulation or mobilisation which found that as a stand-alone treatment, the technique provides only moderate short-term pain relief.

They pointed to other recent, high-quality trials which suggested that manipulation is no better than other treatments such as physical exercise.

In their view, the risks of using manipulation for neck pain outweigh the benefits.

"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," they concluded.

However, not all experts agreed.

Writing in the same edition of the BMJ, Professor David Cassidy, from the University of Toronto, and colleagues argued that cervical spine manipulation should not be abandoned as a treatment for neck pain.

They pointed to high quality evidence that "clearly suggests that manipulation benefits patients with neck pain" and raises doubt about any direct relation between manipulation and stroke.

However, they wanted to see more research into the pros and cons of this technique with the aim of identifying safe and effective treatments.


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