Debates on cervical manipulation almost always focus on safety concerns; Rarely, if ever, do we see views on biological plausibility.

In patients with neck pain, what exactly is supposed to be out of place that therapists are manipulating back? Or is it the spinal equivalent of 'cracking one's knuckles'.

As a surgeon I've treated cervical dislocations, and getting them to move back into place usually takes more force, and a more direct application of that force, than could be applied by the placing of fingers and thumbs over the posterior cervical musculature. I've also seen presentations at meetings demonstrating (in an open MRI scanner) that commonly used manipulative techniques do little more than indent the skin.

I accept that cervical manipulation is 'safe enough' and should not be abandoned on these grounds. For me it should be abandoned, at least from a government funding perspective, on the basis that it is likely to be as effective as homeopathy, and has the same level of biological plausibility, i.e. none.

Competing interests: I see private patients with spinal disorders and often get asked by health insurers to recommend long courses of chiropractic before they will fund them.