Experts Debate Use of Spinal Manipulation for Back Pain

A recent BMJ.com debate explored the controversy surrounding spinal manipulation as a treatment for neck and back pain and whether the practice is dangerous, according to a Washington Post report.

Spinal manipulation is the application of thrusts to the low back or neck to relieve pain. Benedict Wand, PhD, of the school of physiotherapy at the University of Notre Dame Australia, argued that the procedure has not been shown to achieve lasting benefits and that other interventions, such as regular exercise or painkillers, are equally if not more effective. The spinal manipulation treatment, Dr. Wand said, does not justify the risk of stroke and other neurovascular injuries.

David Cassidy, PhD, of the division of epidemiology at the University of Toronto's Dalla Lana School of Public Health, responded that research supports including the procedure as a treatment option for patients. The strokes that occur after manipulations may result from underlying conditions that caused the patient's original neck pain, he said, which would suggest that the spinal adjustment itself did not cause the strokes. The procedure should continue to be offered while more research into its safety is conducted, he said.

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