Volume 28, Issue 7 , Pages 549-550, September 2005
Changes in Cerebellar Blood Flow After Manipulation of the Cervical Spine Using Technetium 99m–Ethyl Cysteinate Dimer
Article Outline
To the Editor:
Cagnie et al1 made a statement in their article that concerns me: “In this study, a lateral manipulation technique was used, as it was considered unethical to use the rotational technique, in view of the knowledge that this technique may be associated with the highest frequency of adverse responses.” However, evidence that any particular vector is riskier than others is at best scant. Even if there were data showing rotational manipulation to be riskier, then the authors would be guilty of having been “unethical” by their own standards because their maneuver included rotation1: “The head was slightly rotated to the right and laterally flexed to the opposite side…” This is a perfect description of a chiropractic adjustive procedure known as the “modified rotary break.” One is at a loss to understand why the authors endorse the modified rotary break and yet find rotation unethical, unless they mean to protest highly rotated maneuvers, in which case most would agree. Indeed, it is not a good idea to use excessive force in any direction, which could result in a sprain/strain.
There is some evidence that upper cervical restrictions are best addressed by rotational manipulation.2 Thus, for whatever increased risk that may be posed by rotational procedures (if any), there may be increased benefits in terms of enhanced rotational range of motion. There are data linking automobile accidents to decreased cervical range of motion; thus, more trauma is conceivably avoided using rotation than trauma created using it.3 As always, intelligent clinical decision making depends on careful risk-benefit analysis. Where this amounts to a question mark divided by question mark, as in this case, it is not helpful to toss around the word “unethical,” which tends to close the door to continuing dialogue.
References
- . Changes in cerebellar blood flow after manipulation of the cervical spine using technetium 99m–ethyl cysteinate dimer. J Manipulative Physiol Ther. 2005;28:103–107
- . Effectiveness of upper versus lower cervical adjustments with respect to the amelioration of passive rotational versus lateral-flexion end-range asymmetries in otherwise asymptomatic subjects. J Manipulative Physiol Ther. 1992;15:99–105
- Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies. Pain. 2003;104:303–322
PII: S0161-4754(05)00195-8
doi:10.1016/j.jmpt.2005.07.017
© 2005 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
Volume 28, Issue 7 , Pages 549-550, September 2005
