So I've been binging on literature lately....One of my first courses at Texas Tech's doctoral program is Advanced Clinical Practice for the Cervicothoracic Junction and Thoracic Outlet. Let me be the first to say I had no idea this part of the body would be quite so involved and interesting at the same time.
Our weekly assignments involve reading research ranging from randomized clinical trials to anatomical reviews. After only one week in this program, I've already picked up some good information I can use in the clinic.
Today's article came from reading some anatomical studies on the vertebral artery. In reading more about the anatomy of this area, my mind wandered to the topic of potential risks for cervical manipulation. The most dramatic adverse events seem to focus on dire occurrances such as stroke. However, we've all seen folks come to our clinics saying they had a range of responses to chiropractic care ranging from pain and stiffness to a worsening of radicular symtoms.
I wondered in particular if the chiropractic profession was any more transparent with reporting adverse events pertaining to cervical manipulation. We've all heard the chiros tell us a manipulation has fewer complications associated with it than taking an NSAID, but we've heard this boy cry wolf before and a little hard data would be nice.
Sure enough, a trial spawned out of the UCLA Neck Pain study attempts to help us learn more. In a randomized clinical trial, a total of 336 patients with neck pain were randomized into three groups of chiropractic care:
- Manipulation with or without heat
- Manipulation with or without electrical stimulation
- Mobilization with or without heat or electrical stimulation
The adverse event in this trial was "discomfort or unpleasant reactions from chiropractic care" assessed at 2 weeks from the baseline assessment. Of the 280 patients who responded, 85 patients (~30%) reported having one or more adverse symptoms as a result of chiropractic care. A total of 212 adverse reactions were reported from the 85 patients who had complications. Of the 212 adverse reactions there were:
- 70 episodes of moderate to severe neck pain or stiffness
- 44 episodes of moderate to severe headaches
- 28 episodes of tiredness or fatigue
Other less common adverse events included dizziness, nausea, depression, tinnitus, arm or leg weakness, blurred vision, confusion or disorientation. Nearly 20 percent of the respondents reported the adverse events had a significant impact on their tolerance for ADL. There is plenty of good data within the results and discussion section to read over so I would encourage you to take a look through it.
The authors, one of whom is a chiropractor, concluded the following:
- Adverse events from chiropractic manipulation are common
- Adverse events are more likely to follow manipulation vs. mobilization
- Chiropractors should consider mobilization over manipulation in the treatment of neck pain, particularly for those with severe pain.
I have bad news for the chiropractic profession... If you take the judicious application of manipulation based on a medical vs holistic model, you get what many well-trained manual physical therapists provide on a daily basis. This study does not bode well for a chiropractic profession that is very slow to let go of its roots in subluxation.
I don't take this study as an indictment of the chiropractic profession, as there are some very skilled manual practitioners out there. However, they dug their own hole in the form of subluxation-based care and are going to have to work hard to dig themselves out. It will be interesting to see if they can do it before the clock runs out on their profession....and believe me it is ticking. Chiropractic tuitions have never been higher and their revenues have never been lower...tick tock...tick tock....!
Hurwitz, E., Morgenstern, H., Vassilaki, M., Chiang, . (2005). Frequency and Clinical Predictors of Adverse Reactions to Chiropractic Care in the UCLA Neck Pain Study. Spine, 30(13), 1477-1484.