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Should we abandon cervical spine manipulation for mechanical neck pain? No

BMJ 2012; 344 doi: (Published 07 June 2012) Cite this as: BMJ 2012;344:e3680
  1. J David Cassidy, professor 1,
  2. Gert Bronfort, professor2,
  3. Jan Hartvigsen, professor3
  1. 1Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Research, Northwestern Health Sciences University, Bloomington, Minnesota, USA
  3. 3Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  1. Correspondence to: J D Cassidy dcassidy{at}

Benedict Wand and colleagues (doi:10.1136/bmj.e3679) argue that the risks of cervical spine manipulation are not justified, but David Cassidy and colleagues think it is a valuable addition to patient care

Manipulation of the cervical spine should not be abandoned. Recently, an international multidisciplinary task force endorsed manipulation as one of several firstline treatments for neck pain, whiplash, and related headaches based on a systematic review of randomised clinical trials of interventions and research on adverse events.1 They also published an original decision analysis model examining drugs, exercise, mobilisation, and manipulation for neck pain, including summary estimates on benefits and harms, and incorporating patient preferences using the standard gamble method.2 Overall, there was no clear winner when the objective was to maximise quality adjusted life.

Another systematic review on conservative interventions for acute neck pain found that manipulation, multimodal physical therapy, neck exercises, and drugs (orphenadrine/paracetamol combined) all had significant short term effects on pain compared with placebo.3 In addition, acupuncture and manipulation had significant short term effects on disability compared with placebo. Thus the evidence clearly suggests that manipulation benefits patients with neck pain. Furthermore, a recent high quality trial found spinal manipulation more effective for acute and subacute neck pain, over both the short and long term, than …

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