Spinal manipulation has existed since four hundred BCE in Europe but didn’t become a medical profession until the nineteenth century. But just because the practice has been around for a long time doesn’t mean that it doesn’t face scrutiny. Since the beginning it has fallen in and out of favor with the medical community due to its risky and seemingly simplistic nature, but luckily it is now on the upswing of popularity (Pettman). Spinal manipulation is a useful and invaluable practice that is, while risky, provides effective and non-invasive solutions to many patients’ physical problems.
Manipulation of the spine (or MTS) is a process used by chiropractors in which the doctor uses high-velocity thrusts onto the patient’s spine in order to adjust the vertebrae. MTS can be performed through the use of both long and short lever-arms; using long lever-arms for macro-manipulations of several vertebrae (with greater risk) while using short lever-arms are particularly used for micro-interactions (with smaller risk). Spinal manipulation therapy is still a fairly controversial therapy method and, although there is some risk, even skeptical doctors can’t deny the uses that MTS holds.
MTS has been used to treat back pain. An example of this is a 2015 case where a sixty-six year old woman went to the doctor’s office complaining of a “left-sided mid-thoracic pain that radiated anteriorly to her lower chest and upper abdomen” (Chung). The woman stated that while normally the pain was a dull throbbing, upon extension/rotation of the spine and left arm, as well as coughing, a sharp pain was released throughout the body; doctors diagnosed her with acute costovertebral joint dysfunction. The woman proceeded to attend four separate physical therapy sessions in which she underwent spinal manipulation; each time she reported feeling immediate relief after her session and after the fourth session her ailment had ceased to persist (Chung). This was the first case study in which MTS was recorded treating acute symptomatic thoracic spine pain, not only proving that spinal manipulation is an effective medical practice but also proving that MTS is gaining traction in the medical field and is becoming more widely adopted.
Spinal manipulation can be used to treat certain types of chronic headaches as well. In a 1997 study done by Dr. Niels Nilsson fifty-three patients who suffered from chronic cervicogenic headaches were given treatment twice a week, twenty-eight were given high velocity manipulations while twenty-five were given low-level lasers, over the period of five weeks. The study showed that MTS reduced analgesics (pain relief medicine) consumption by thirty-six percent while the low-level laser group portrayed no change; there was a sixty-nine percent decrease in headaches hours per day in the MTS group, compared to the thirty-seven percent decrease in the low-level laser group; and a thirty-six percent decrease in cervicogenic headache pain, which is more than double the seventeen percent decrease in the low-level laser group (Nilsson). So, using this information, Nilsson was able to undoubtedly confirm that spinal manipulation is a viable headache relief technique.
As stated before, manipulating the spine isn’t completely safe as adverse side effects have been known to occur in patients who undergo this therapy. In a case search study spanning over five years (2001-2006), Dr. Edzand Ernst analyzed more than thirty case reports covering follow-ups on patients who underwent MTS. He found that over two hundred patients were seriously harmed due to their MTS procedure, usually due to vertebral artery dissections. In the same search, evidence showed that not only did relatively mild adverse effects occur in 30%-61% of patients but that not all serious adverse side effects are reported, so the numbers are in reality higher than those listed (Ernst). With anywhere between a one-third and two-thirds chance of suffering from serious side effects, multiple doctors question whether the costs outweigh the benefits and even if MTS should be practiced at all.
There is a special type of spinal manipulation is called “manipulation of the cervical spine” or MCS for short. MCS is performed by the chiropractor applying slow thrusts onto the cervical spine, sacrificing manipulation for mobilization. Like MTS, MCS can be used with both long and short lever-arms with similar intentions, uses, results, and risks. This form of chiropractic therapy is primarily used to relieve neck pains and muscle-tension headaches or migraines, like MTS, but with more sensitive ailments. Another benefit of MCS is that, unlike MTS, patients can prevent joint movement if they so choose.
On top of being used to relieve pain, cervical spine manipulation can be used to increase range of motion. Dr. Wayne Whittingham and Dr. Niels Nisson (the same doctor from the chronic headache and MTS study) researched the effects of MCS on active ranges of motion in a 2001 study of one hundred five patients with cervicogenic headaches. In the first trial of this study, Group 1 received sham manipulation while Group 2 received toggle recoil cervical manipulation; in the second trial Group 1 received toggle recoil MCS and Group 2 received no treatment; in the final trial Group 3 got no treatment and Group 2 underwent sham manipulation; and after each trial the participants had their active range of motion recorded using a goniometer. After analyzing the collected data, Whittingham and Nilsson found that after the first trial Group 2 exhibited superior ranges of motion over Group 1, but after Group 1 received MCS the differences disappeared (Whittingham). Therefore, with this information, the doctors were able to conclude that cervical spinal manipulation has a massive increase in patients’ active ranges of motion.
Many doctors believe MCS to be an almost completely safe practice with minimal aversions, both minor and major. In 2007 a UK set of physicians observed the treatment outcomes of 19,722 patients over the first week following their manipulations. After 28,807 treatment consultations and 50,276 spine manipulations Dr. Thiel received a shocking grand total of zero reports of serious adversities overcoming the patients. Using this information these doctors calculated a risk of 0.0001% of a serious adverse event occurring immediately after the manipulation, 0.0002% after the first week and 0.0006% at all (Thiel). However while the chances of a serious adversity occurring was exceedingly slim, the chances of a minor side effect taking place is only slightly slim. Dr.’s Thiel, Bolton, Docherty, and Portlock found a 0.016% and 0.013% chance of dizziness/fainting immediately proceeding and a week after manipulation (respectively), plus a 0.04% chance of a headache and 0.015% chance of numbness in upper limbs within the first week (Thiel). So while MCS may not be completely safe, these doctors believe that the risks of the process is near nonexistent.
Not every doctor agrees with Dr. Thiel however. Dr. Richard Di Fabio has research that claims that MCS not only leads to lesions of the brain stem, vertebral artery damage, spasms, arterial dissection, and even death, but it is also likely. In a seventy-two year study ending in 1997, there was a reported 18% fatality rate among patients (one of the highest mortality rates among all chiropractic practices) (Di Fabio). However even Dr. Di Fabio that these numbers may not be completely accurate as it only examines about thirty-five percent of the total manipulations as forty-five percent were never recorded and twenty percent were never translated.
As it has been shown, spinal manipulation is controversial to say the least. While being effective in various forms of pain relief such as treating chronic cervicogenic headaches and back pain, certain studies have found the risks of vertebral artery dissections or even death is relatively high. While more doctors favor spinal manipulation than those who oppose it, according to Dr. Pettman’s pendulum theory of popularity MTS is long overdue for a sudden decrease in reputation. Despite all this, when comparing guaranteed relief to a chronic problem to the small possibility of adverse side effects, spinal manipulation is nevertheless an invaluable practice whose benefits greatly outweigh the risks.
Sources:
Manipulation of the spine (or MTS) is a process used by chiropractors in which the doctor uses high-velocity thrusts onto the patient’s spine in order to adjust the vertebrae. MTS can be performed through the use of both long and short lever-arms; using long lever-arms for macro-manipulations of several vertebrae (with greater risk) while using short lever-arms are particularly used for micro-interactions (with smaller risk). Spinal manipulation therapy is still a fairly controversial therapy method and, although there is some risk, even skeptical doctors can’t deny the uses that MTS holds.
MTS has been used to treat back pain. An example of this is a 2015 case where a sixty-six year old woman went to the doctor’s office complaining of a “left-sided mid-thoracic pain that radiated anteriorly to her lower chest and upper abdomen” (Chung). The woman stated that while normally the pain was a dull throbbing, upon extension/rotation of the spine and left arm, as well as coughing, a sharp pain was released throughout the body; doctors diagnosed her with acute costovertebral joint dysfunction. The woman proceeded to attend four separate physical therapy sessions in which she underwent spinal manipulation; each time she reported feeling immediate relief after her session and after the fourth session her ailment had ceased to persist (Chung). This was the first case study in which MTS was recorded treating acute symptomatic thoracic spine pain, not only proving that spinal manipulation is an effective medical practice but also proving that MTS is gaining traction in the medical field and is becoming more widely adopted.
Spinal manipulation can be used to treat certain types of chronic headaches as well. In a 1997 study done by Dr. Niels Nilsson fifty-three patients who suffered from chronic cervicogenic headaches were given treatment twice a week, twenty-eight were given high velocity manipulations while twenty-five were given low-level lasers, over the period of five weeks. The study showed that MTS reduced analgesics (pain relief medicine) consumption by thirty-six percent while the low-level laser group portrayed no change; there was a sixty-nine percent decrease in headaches hours per day in the MTS group, compared to the thirty-seven percent decrease in the low-level laser group; and a thirty-six percent decrease in cervicogenic headache pain, which is more than double the seventeen percent decrease in the low-level laser group (Nilsson). So, using this information, Nilsson was able to undoubtedly confirm that spinal manipulation is a viable headache relief technique.
As stated before, manipulating the spine isn’t completely safe as adverse side effects have been known to occur in patients who undergo this therapy. In a case search study spanning over five years (2001-2006), Dr. Edzand Ernst analyzed more than thirty case reports covering follow-ups on patients who underwent MTS. He found that over two hundred patients were seriously harmed due to their MTS procedure, usually due to vertebral artery dissections. In the same search, evidence showed that not only did relatively mild adverse effects occur in 30%-61% of patients but that not all serious adverse side effects are reported, so the numbers are in reality higher than those listed (Ernst). With anywhere between a one-third and two-thirds chance of suffering from serious side effects, multiple doctors question whether the costs outweigh the benefits and even if MTS should be practiced at all.
There is a special type of spinal manipulation is called “manipulation of the cervical spine” or MCS for short. MCS is performed by the chiropractor applying slow thrusts onto the cervical spine, sacrificing manipulation for mobilization. Like MTS, MCS can be used with both long and short lever-arms with similar intentions, uses, results, and risks. This form of chiropractic therapy is primarily used to relieve neck pains and muscle-tension headaches or migraines, like MTS, but with more sensitive ailments. Another benefit of MCS is that, unlike MTS, patients can prevent joint movement if they so choose.
On top of being used to relieve pain, cervical spine manipulation can be used to increase range of motion. Dr. Wayne Whittingham and Dr. Niels Nisson (the same doctor from the chronic headache and MTS study) researched the effects of MCS on active ranges of motion in a 2001 study of one hundred five patients with cervicogenic headaches. In the first trial of this study, Group 1 received sham manipulation while Group 2 received toggle recoil cervical manipulation; in the second trial Group 1 received toggle recoil MCS and Group 2 received no treatment; in the final trial Group 3 got no treatment and Group 2 underwent sham manipulation; and after each trial the participants had their active range of motion recorded using a goniometer. After analyzing the collected data, Whittingham and Nilsson found that after the first trial Group 2 exhibited superior ranges of motion over Group 1, but after Group 1 received MCS the differences disappeared (Whittingham). Therefore, with this information, the doctors were able to conclude that cervical spinal manipulation has a massive increase in patients’ active ranges of motion.
Many doctors believe MCS to be an almost completely safe practice with minimal aversions, both minor and major. In 2007 a UK set of physicians observed the treatment outcomes of 19,722 patients over the first week following their manipulations. After 28,807 treatment consultations and 50,276 spine manipulations Dr. Thiel received a shocking grand total of zero reports of serious adversities overcoming the patients. Using this information these doctors calculated a risk of 0.0001% of a serious adverse event occurring immediately after the manipulation, 0.0002% after the first week and 0.0006% at all (Thiel). However while the chances of a serious adversity occurring was exceedingly slim, the chances of a minor side effect taking place is only slightly slim. Dr.’s Thiel, Bolton, Docherty, and Portlock found a 0.016% and 0.013% chance of dizziness/fainting immediately proceeding and a week after manipulation (respectively), plus a 0.04% chance of a headache and 0.015% chance of numbness in upper limbs within the first week (Thiel). So while MCS may not be completely safe, these doctors believe that the risks of the process is near nonexistent.
Not every doctor agrees with Dr. Thiel however. Dr. Richard Di Fabio has research that claims that MCS not only leads to lesions of the brain stem, vertebral artery damage, spasms, arterial dissection, and even death, but it is also likely. In a seventy-two year study ending in 1997, there was a reported 18% fatality rate among patients (one of the highest mortality rates among all chiropractic practices) (Di Fabio). However even Dr. Di Fabio that these numbers may not be completely accurate as it only examines about thirty-five percent of the total manipulations as forty-five percent were never recorded and twenty percent were never translated.
As it has been shown, spinal manipulation is controversial to say the least. While being effective in various forms of pain relief such as treating chronic cervicogenic headaches and back pain, certain studies have found the risks of vertebral artery dissections or even death is relatively high. While more doctors favor spinal manipulation than those who oppose it, according to Dr. Pettman’s pendulum theory of popularity MTS is long overdue for a sudden decrease in reputation. Despite all this, when comparing guaranteed relief to a chronic problem to the small possibility of adverse side effects, spinal manipulation is nevertheless an invaluable practice whose benefits greatly outweigh the risks.
Sources:
- http://ptjournal.apta.org/content/79/1/50.full
- http://jrs.sagepub.com/content/100/7/330.short
- http://europepmc.org/abstract/med/9200048
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565620/
- http://journals.lww.com/spinejournal/Abstract/2007/10010/Safety_of_Chiropractic_Manipulation_of_the.16.aspx
- http://www.sciencedirect.com/science/article/pii/S0161475401251343