What is manipulation?

Manipulation is one of the skills held by physiotherapists in the treatment of musculo skeletal conditions. It is often referred to as a ‘high velocity thrust’ technique and may produce an audible ‘click’ as the joint releases. It can be defined clinically as techniques used to force a joint beyond its presumed physiologic barrier and up to its anatomical barrier (Haldeman & Hooper 1999).

Physiotherapists have been developing manual therapy techniques for over 100 years and have produced significant research into the effect of these techniques. Osteopaths, Chiropractors, Medical Doctors also use manipulation techniques.The MACP is a special interest group of the Chartered Society of Physiotherapists who have a web site (macp-online.co.uk) for further information.

Short term relief only

Claims on the effect of manipulation vary from the specific to ‘cure alls’. Research evidence examining the efficacy of manipulation has demonstrated it to only provide short term benefit for pain and stiffness (see Clinical Evedence Vol 4 BMJ review guide). There is no reliable evidence to suggest manipulations can make ‘adjustments’ to your spinal ‘alignment’ or ‘positional faults’ (Dalsth 1976). There is furthermore no evidence that manipulation aids the return of prolapsed disc material which in lay terms is called ‘slipped disc’ (Mathews & Yates 1969 and Bourdillon and Day 1987).

Therefore we use manipulation as part of a clients management package rather then the total treatment as suggested in the government research review and clinical guidelines into low back pain CSAG (1997) which advocated nationally by G.P.’s.

Can manipulation damage?

Unfortunately manipulation is not 100% safe. Disc herniation, cervical artery damage (VBA), spinal cord compression, death, strokes, nerve root compression, paraplegia, vertebral fractures and embolic events are all documented (Stevenson et al 2001, Grieve 1994, Dupeyron et al 2003, and Assendelft et al 1996). Furhtermore, pre-manipulative screening has not eradicated accidents (Halderman et al 2002). The average age for stroke post manipulation is 38 years old although incidence is between 1:20,000 and 1:4,000,000

Conclusion

Patients should be aware of the associated risks therefore of especially cervical manipulation and then make an informed decision before agreeing to this form of treatment. However, if patients are selected correctly and the technique performed well it can be effective, pain free, and a relatively safe technique. We do perform manipulation at the Grange but considering the range of treatment options physiotherapy has to offer this would not be our primary treatment especially at the cervical spine.