Cervical manipulation, commonly known as neck manipulation, is a procedure involving adjustment of the upper seven vertebrae of the spinal column. This procedure is most often utilized by chiropractors, as well as osteopathic physicians who practice osteopathic manipulation. [1] This type of manipulation may increase the risk of stroke and other issues, with studies suggesting the relationship is causative. [2] [3] [4]
The cervical areas is located in the upper neck region of the spine from C1 to C7 .
Many types of practitioners use various techniques to adjust the position of the cervical bones. They include bonesetters, physical therapists, chiropractors, non-physician osteopaths, and osteopathic physicians. The various techniques range from high velocity low amplitude thrusts to gentle positional release techniques such as Brett's Procedure.
There are associated risks that come with cervical manipulation including spinal disc herniation, stroke and vertebral artery dissection. Chances of stroke may be increased due to possible tears in neck arteries, known as cervical dissection, and is among the most common causes of stroke for young and middle-aged adults. [5] However, it is difficult to quantify this risk, with a 2012 meta analysis of previous studies stating that a significant risk "can not be ruled out", but noted that the true risk is possibly drastically underestimated, owing to the lack of a reporting requirement for private chiropractic practitioners. [6]
Chiropractic is a form of alternative medicine concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine. It has esoteric origins and is based on several pseudoscientific ideas.
In the pseudoscientific alternative medicine chiropractic, a vertebral subluxation means pressure on nerves, abnormal functions creating a lesion in some portion of the body, either in its action, or makeup, not necessarily visible on X-rays.
Manual therapy, or manipulative therapy, is a physical treatment primarily used by physical therapists, physiotherapists, occupational therapists to treat musculoskeletal pain and disability; it mostly includes kneading and manipulation of muscles, joint mobilization and joint manipulation. It is also used by Rolfers, massage therapists, athletic trainers, osteopaths, and physicians.
The vertebral arteries are major arteries of the neck. Typically, the vertebral arteries originate from the subclavian arteries. Each vessel courses superiorly along each side of the neck, merging within the skull to form the single, midline basilar artery. As the supplying component of the vertebrobasilar vascular system, the vertebral arteries supply blood to the upper spinal cord, brainstem, cerebellum, and posterior part of brain.
Spinal adjustment and chiropractic adjustment are terms used by chiropractors to describe their approaches to spinal manipulation, as well as some osteopaths, who use the term adjustment.
Spinal manipulation is an intervention performed on spinal articulations, synovial joints, which is asserted to be therapeutic. These articulations in the spine that are amenable to spinal manipulative therapy include the z-joints, the atlanto-occipital, atlanto-axial, lumbosacral, sacroiliac, costotransverse and costovertebral joints. National guidelines come to different conclusions with respect to spinal manipulation with some not recommending it, and others recommending a short course in those who do not improve with other treatments.
Carotid artery dissection is a separation of the layers of the artery wall supplying oxygen-bearing blood to the head and brain and is the most common cause of stroke in young adults.
Vertebral artery dissection (VAD) is a flap-like tear of the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. After the tear, blood enters the arterial wall and forms a blood clot, thickening the artery wall and often impeding blood flow. The symptoms of vertebral artery dissection include head and neck pain and intermittent or permanent stroke symptoms such as difficulty speaking, impaired coordination and visual loss. It is usually diagnosed with a contrast-enhanced CT or MRI scan.
Cervical lymph nodes are lymph nodes found in the neck. Of the 800 lymph nodes in the human body, 300 are in the neck. Cervical lymph nodes are subject to a number of different pathological conditions including tumours, infection and inflammation.
The history of chiropractic began in 1895 when Daniel David Palmer of Iowa performed the first chiropractic adjustment on a partially deaf janitor, Harvey Lillard. While Lillard was working without his shirt on in Palmer's office, Lillard bent over to empty the trash can. Palmer noticed that Lillard had a vertebra out of position. He asked Lillard what happened, and Lillard replied, "I moved the wrong way, and I heard a 'pop' in my back, and that's when I lost my hearing." Palmer, who was also involved in many other natural healing philosophies, had Lillard lie face down on the floor and proceeded with the adjustment. The next day, Lillard told Palmer, "I can hear that rackets on the streets." This experience led Palmer to open a school of chiropractic two years later. Rev. Samel Weed coined the word "chiropractic" from Greek root. Chiropractic's early philosophy was rooted in vitalism, naturalism, magnetism, spiritualism and other constructs that are not amenable to the scientific method, although Palmer tried to merge science and metaphysics. In 1896, Palmer's first descriptions and underlying philosophy of chiropractic echoed Andrew Still's principles of osteopathy established a decade earlier. Both described the body as a "machine" whose parts could be manipulated to produce a drugless cure. Both professed the use of spinal manipulation on joint dysfunction/subluxation to improved health. Palmer distinguished his work by noting that he was the first to use short-lever HVLA manipulative techniques using the spinous process and transverse processes as mechanical levers. He described the effects of chiropractic spinal manipulation as being mediated primarily by the nervous system.
Joint manipulation is a type of passive movement of a skeletal joint. It is usually aimed at one or more 'target' synovial joints with the aim of achieving a therapeutic effect.
Manipulation under anesthesia (MUA) or fibrosis release procedures is a multidisciplinary, chronic pain-related manual therapy modality which is used for the purpose of improving articular and soft tissue movement. This is accomplished by way of a combination of controlled joint mobilization/manipulation and myofascial release techniques. Medication-assisted manipulation (MAM) may also be used to describe the procedure, although that term more broadly categorizes the varied forms of existing MUA techniques. In any form, MUA is used by osteopathic/orthopedic physicians and specially trained chiropractors. It is intended as a means of breaking up adhesions of or about spinal joints, or extremity joint articulations to which painfully restricted range of motion significantly limits function. Failed attempts at other standard conservative treatment methods, over a sufficient time-frame, is one of the principal patient qualifiers.
Cervical artery dissection is dissection of one of the layers that compose the carotid and vertebral artery in the neck (cervix). They include:
Chiropractors use their version of spinal manipulation as their primary treatment method, with non-chiropractic use of spinal manipulation gaining more study and attention in mainstream medicine in the 1980s. There is no evidence that chiropractic spinal adjustments are effective for any medical condition, with the possible exception of treatment for lower back pain. The safety of manipulation, particularly on the cervical spine has been debated. Adverse results, including strokes and deaths, are rare.
NUCCA is an acronym for the National Upper Cervical Chiropractic Association. It was founded in 1966 by chiropractor Ralph Gregory and based primarily upon the work he and John Grostic had performed before Grostic's death in 1964. The new style of upper cervical adjusting technique was taught in 1966 at the first NUCCA seminar, which was held at the Howard Johnson Motel in Monroe, Michigan.
Throughout its history chiropractic has been the subject of internal and external controversy and criticism. According to magnetic healer Daniel D. Palmer, the founder of chiropractic, "vertebral subluxation" was the sole cause of all diseases and manipulation was the cure for all disease. A 2003 profession-wide survey found "most chiropractors still hold views of Innate Intelligence and of the cause and cure of disease consistent with those of the Palmers". A critical evaluation stated "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today." Chiropractors, including D.D. Palmer, were jailed for practicing medicine without a license. D.D. Palmer considered establishing chiropractic as a religion to resolve this problem. For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation.
Veterinary chiropractic, also known as animal chiropractic, is the practice of spinal manipulation or manual therapy for animals. Veterinary chiropractors typically treat horses, racing greyhounds, and pets. Veterinary chiropractic is a fast-developing field that is complementary to the conventional approach.
Osteomyology is a form of alternative medicine found almost exclusively in the United Kingdom and is loosely based on aggregated ideas from other manipulation therapies, principally chiropractic and osteopathy. Osteomyologists are often therapists who have usually been trained in osteopathy or chiropractic but take on the title osteomyologist after they have refused to be regulated by the General Osteopathic Council (GOsC) or the General Chiropractic Council (GCC) for political or philosophical reasons, or cannot join as they have not submitted the required papers to the governing bodies or achieved training standards necessary to satisfy the terms of the acts of parliament.
Daniel David Palmer or D.D. Palmer was a Canadian American chiropractor who was the founder of chiropractic. Palmer was born in Port Perry, Ontario, but emigrated to the United States. He was also an avid proponent of various other forms of pseudoscientific alternative medicine such as magnetic healing. Palmer opposed anything he thought to be associated with mainstream medicine such as vaccination.
Primary spine practitioners are health care professionals who are specially trained to provide primary care for patients with spinal disease. The PSP has the training necessary to provide differential diagnosis, rule out serious pathology and provide evidence-based management for the majority of patients with spinal disease. Evidence-based treatment methods include spinal manipulation and manual therapy, rehabilitative exercises, patient education, motivational techniques and the application of psychological principles, particularly those of cognitive-behavioral therapy and acceptance and commitment therapy. In addition, the PSP has the ability to recognize the relatively few patients who require special tests and invasive procedures and to serve as the center of care for the purpose of providing counseling for the patient, coordination of care and long term follow up. An important aspect of this role is educating the patient on the risks, benefits and research evidence of all treatments for spinal pain so that, through a shared decision making process, appropriate choices can be made as to what is the best treatment for the patient.