A poll in this week’s BMJ is out seeking professional opinion on if cervical spine manipulation should be abandoned.  Definitely a hot topic as always.  I don’t have access to the full article on statements by Cassidy et al for “NO” or Wand et al for “YES” but you can read the responses by several practitioners below.

YES, it should be abandoned: found here (click on read responses) 

NO, it should not be abandoned: found here (click on read responses) 

In short, I do not think it should be abandoned; that is quite a leap.  But, I do know there are risks involved.  There are risk involved in mobilizations of the cervical spine, its just not scrutinized as deeply.   It comes down to using clinical judgement based on the patient presentation in front of you if you feel this is the right modality of choice.  A positive aspect of a physical therapist’s diverse treatment approach is that we have other tools up our sleeves if we feel the risk reward relationship is compromised.  

I teach obtaining a thorough medical history (mainly involving the therapist asking the right questions as pertinent data doesn’t usually pop out on its own) as the main clinical decision making tool.  This precedes any other objective measures (which have poor validity) or psychomotor skills.  

I recommend reading clinical guidelines below as can be found online:

IFOMPT: Framework for Examination of the Cervical Spine Region prior to Orthopedic Manual Therapy (OMT) Intervention. 

Australian Physiotherapy Clinical Guidelines: Assessing Vertebrobasilar Insufficiency in the Management of Cervical Spine Disorders



    1. It could. We do not know the exact risk but dissection of the cervical arteries would be the most problematic. Using proper clinical reasoning, screening tools and clinical judgment will assist in you making the right decision.

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