Monday, June 25, 2007

Is cervical spine manipulation dangerous ?

Yes Cspine manipulation is dangerous, but not that dangerous...

The risk is about 1/1.5million. It seems quite a lot but in fact you have more chances to die being struck by lightning !

Taking pills (NSAID) may seem safer, but in fact 16000 deaths a year in the US alone are attributed to the use of these painkillers. This gives a ratio of 500/1m people dying from gastric bleeding from taking anti-inflammatories. I won't even start to talk about liver intoxication associated with paracetamol.

So what is dangerous about it ?
in fact the danger comes from the rupture of the cervical artery or from a migration of atherothrombosis during the cervical manipulation which leads to a CVA or death.
Caution must be taken with :

  • patients suffering from High Blood Pressure (walls of arteries are more rigid and/or presence of cholesterol)
  • patients suffering from high cholesterol
  • patients suffering from hyperlaxity or connective tissue disorder (eg: Marfan syndrome)
  • patients suffering from vertebral atery occlusion syndrome
At a more practical level the aim is to reduce the number of cervical manipulation. And believe me a painful neck is not necessarly a neck to be manipulated !!! I've been horrified to hear patients telling me that they were seeing their therapist up to 3 times a week to have their neck manipulated.

The cause of your neck pain may not come from your neck !
This little test can be performed on yourself or on your patient. The patient sits on the table and you ask him to look over the right and left shoulder, check the rotation and ask the patients to notice when they feel the pain. Now, place your hands underneath the diaphragm and gently lift it up (liver, stomach...) and ask your patient to rotate his head again. Any change in the rotation or in the pain indicate that there is probably no need to manipulate the Cspine, the problem is coming from somewhere else. Yes this may sound odd but a gastritis, an anterior tilt of the liver, a Csection scar... can create neck pain.

Is it a problem if I "crack" my neck myself ?
It is not such a problem if you manage to do it at the right spot ! Often we tend to manipulate the part which is painful and this is not necessarly the right vertebrae or part of the body to manipulate. By moving the vertebral joint you will make it looser, if you manipulate it too often this joint will become hypermobile. To stabilize it, muscles will contract, this is painful and you feel the urge to crack it again... a splendid vicious circle. In other words, if you keep "cracking" the same vertebrae I seriously doubt that this is the right one to move and this will cause you other problem on the long run.


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