Chiropractic - Safety: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(New page: === Safety === Chiropractic care in general is safe when employed skillfully and appropriately. Its primary therapeutic procedure, spinal manipulation, involves directed thrust to move a ...)
 
 
(2 intermediate revisions by the same user not shown)
Line 1: Line 1:
=== Safety ===
'''Editor-in-Chief:''' [[User:Drsjpdc  |Dr. Stephen J. Press]] [mailto:drsjp@drpress.com]
{{EJ1}}


Chiropractic care in general is safe when employed skillfully and appropriately. Its primary therapeutic procedure, spinal manipulation, involves directed thrust to move a joint past its physiological range of motion without exceeding the anatomical limit. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications.<ref name=WHO-guidelines/> Absolute [[contraindication]]s to spinal manipulation are conditions that should not be manipulated; these contraindications include [[rheumatoid arthritis]] and conditions known to result in unstable joints. Relative contraindications are conditions where increased risk is acceptable in some situations and where low-force and soft-tissue techniques are treatments of choice; these contraindications include [[osteoporosis]].<ref name=WHO-guidelines/> Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to [[emergency medical services]]; these include sudden and severe [[headache]] or [[neck pain]] unlike that previously experienced.<ref name=CCA-CFCREAB-CPG>{{cite journal |journal= J Can Chiropr Assoc |date=2005 |volume=49 |issue=3 |pages=158–209 |title= Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash |author= Anderson-Peacock E, Blouin JS, Bryans R ''et al.'' |url=http://www.jcca-online.org/Client/cca/jcca.nsf/objects/jcca-v49-3-158/$file/jcca-v49-3-158.pdf |format=PDF}}<br/>&nbsp;• {{cite journal |journal= J Can Chiropr Assoc |date=2008 |volume=52 |issue=1 |pages=7–8 |title= A clinical practice guideline update from The CCA•CFCREAB-CPG |author= Anderson-Peacock E, Bryans B, Descarreaux M ''et al.'' |url=http://www.jcca-online.org/Client/cca/JCCA.nsf/objects/JCCA_March_2008_52_1/$file/jcca-v52-1-007.pdf |format=PDF}}</ref>
[[Chiropractic | Chiropractic  Main Article]]


Spinal manipulation is associated with frequent, mild and temporary [[Adverse effect (medicine)|adverse effects]],<ref name=CCA-CFCREAB-CPG/><ref name=Ernst-adverse/> including new or worsening pain or stiffness in the affected region.<ref name=Thiel>{{cite journal |journal=Spine |date=2007 |volume=32 |issue=21 |pages=2375–8 |title= Safety of chiropractic manipulation of the cervical spine: a prospective national survey |author= Thiel HW, Bolton JE, Docherty S, Portlock JC |pmid=17906581}}</ref> They have been estimated to occur in 34% to 55% of patients, with 80% of them disappearing within 24 hours.<ref name=CCA-CFCREAB-CPG/> Rarely, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults<ref name=Ernst-adverse>{{cite journal |journal= J R Soc Med |date=2007 |volume=100 |issue=7 |pages=330–8 |title= Adverse effects of spinal manipulation: a systematic review |author= Ernst E |pmid=17606755 |url=http://www.jrsm.org/cgi/content/full/100/7/330}}</ref> and children.<ref name=Vohra>{{cite journal |journal=Pediatrics |date=2007 |volume=119 |issue=1 |pages=e275–83 |title= Adverse events associated with pediatric spinal manipulation: a systematic review |author= Vohra S, Johnston BC, Cramer K, Humphreys K |doi=10.1542/peds.2006-1392 |pmid=17178922 |url=http://pediatrics.aappublications.org/cgi/content/full/119/1/e275}}</ref> The [[Incidence (epidemiology)|incidence]] of these complications is unknown, due to rarity, high levels of underreporting, and difficulty of linking manipulation to adverse effects such as stroke, a particular concern.<ref name=Ernst-adverse/> Several case reports show temporal associations between interventions and potentially serious complications.<ref name=Hurwitz-2008/> [[Vertebrobasilar artery stroke]] is [[Association (statistics)|statistically associated]] with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.<ref name=Hurwitz-2008>{{cite journal |journal=Spine |date=2008 |volume=33 |issue= 4 Suppl |pages=S123–52 |title= Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders |author= Hurwitz EL, Carragee EJ, van der Velde G ''et al.'' |doi=10.1097/BRS.0b013e3181644b1d |pmid=18204386}}</ref> Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy (whether chiropractic or not) and vertebrobasilar artery stroke.<ref>{{cite journal |journal=Neurologist |date=2008 |volume=14 |issue=1 |pages=66–73 |title= Does cervical manipulative therapy cause vertebral artery dissection and stroke? |author= Miley ML, Wellik KE, Wingerchuk DM, Demaerschalk BM |doi=10.1097/NRL.0b013e318164e53d |pmid=18195663}}</ref>
Chiropractic care in general is safe when employed skillfully and appropriately. Its primary therapeutic procedure, spinal manipulation, involves directed thrust to move a joint past its physiological range of motion without exceeding the anatomical limit. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications.<ref name=WHO-guidelines/> Absolute [[contraindication]]s to spinal manipulation are conditions that should not be manipulated; these contraindications include spinal involvement in [[rheumatoid arthritis]] and metastatic conditions known to result in unstable joints. Relative contraindications are conditions where increased risk is acceptable in some situations and where low-force and soft-tissue techniques are treatments of choice; these contraindications include [[osteoporosis]].<ref name=WHO-guidelines/> Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to [[emergency medical services]]; these include sudden and severe [[headache]] or [[neck pain]] unlike that previously experienced.<ref name=CCA-CFCREAB-CPG>{{cite journal |journal= J Can Chiropr Assoc |date=2005 |volume=49 |issue=3 |pages=158–209 |title= Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash |author= Anderson-Peacock E, Blouin JS, Bryans R ''et al.'' |url=http://www.jcca-online.org/Client/cca/jcca.nsf/objects/jcca-v49-3-158/$file/jcca-v49-3-158.pdf |format=PDF}}<br/>&nbsp;• {{cite journal |journal= J Can Chiropr Assoc |date=2008 |volume=52 |issue=1 |pages=7–8 |title= A clinical practice guideline update from The CCA•CFCREAB-CPG |author= Anderson-Peacock E, Bryans B, Descarreaux M ''et al.'' |url=http://www.jcca-online.org/Client/cca/JCCA.nsf/objects/JCCA_March_2008_52_1/$file/jcca-v52-1-007.pdf |format=PDF}}</ref>
 
Spinal manipulation is associated with frequent, mild and temporary [[Adverse effect (medicine)|adverse effects]],<ref name=CCA-CFCREAB-CPG/> including new or worsening pain or stiffness in the affected region.<ref name=Thiel>{{cite journal |journal=Spine |date=2007 |volume=32 |issue=21 |pages=2375–8 |title= Safety of chiropractic manipulation of the cervical spine: a prospective national survey |author= Thiel HW, Bolton JE, Docherty S, Portlock JC |pmid=17906581}}</ref> They have been estimated to occur in 34% to 55% of patients, with 80% of them disappearing within 24 hours.<ref name=CCA-CFCREAB-CPG/> Rarely, it has been alleged that spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults<ref name=Ernst-adverse>{{cite journal |journal= J R Soc Med |date=2007 |volume=100 |issue=7 |pages=330–8 |title= Adverse effects of spinal manipulation: a systematic review |author= Ernst E |pmid=17606755 |url=http://www.jrsm.org/cgi/content/full/100/7/330}}</ref> and children.<ref name=Vohra>{{cite journal |journal=Pediatrics |date=2007 |volume=119 |issue=1 |pages=e275–83 |title= Adverse events associated with pediatric spinal manipulation: a systematic review |author= Vohra S, Johnston BC, Cramer K, Humphreys K |doi=10.1542/peds.2006-1392 |pmid=17178922 |url=http://pediatrics.aappublications.org/cgi/content/full/119/1/e275}}</ref> [[Vertebrobasilar artery stroke]] is [[Association (statistics)|statistically associated]] with chiropractic services in persons under 45 years of age, '''but it is similarly associated with general practitioner services''', suggesting that these associations are likely explained by preexisting conditions.<ref name=Hurwitz-2008>{{cite journal |journal=Spine |date=2008 |volume=33 |issue= 4 Suppl |pages=S123–52 |title= Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders |author= Hurwitz EL, Carragee EJ, van der Velde G ''et al.'' |doi=10.1097/BRS.0b013e3181644b1d |pmid=18204386}}</ref>  
 
==References==
{{Reflist}}

Latest revision as of 21:57, 7 December 2010

Editor-in-Chief: Dr. Stephen J. Press [1]

Please Join in Editing This Page and Apply to be an Editor-In-Chief for this topic:

There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.


Chiropractic Main Article

Chiropractic care in general is safe when employed skillfully and appropriately. Its primary therapeutic procedure, spinal manipulation, involves directed thrust to move a joint past its physiological range of motion without exceeding the anatomical limit. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications.[1] Absolute contraindications to spinal manipulation are conditions that should not be manipulated; these contraindications include spinal involvement in rheumatoid arthritis and metastatic conditions known to result in unstable joints. Relative contraindications are conditions where increased risk is acceptable in some situations and where low-force and soft-tissue techniques are treatments of choice; these contraindications include osteoporosis.[1] Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to emergency medical services; these include sudden and severe headache or neck pain unlike that previously experienced.[2]

Spinal manipulation is associated with frequent, mild and temporary adverse effects,[2] including new or worsening pain or stiffness in the affected region.[3] They have been estimated to occur in 34% to 55% of patients, with 80% of them disappearing within 24 hours.[2] Rarely, it has been alleged that spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults[4] and children.[5] Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.[6]

References

  1. ↑ 1.0 1.1
  2. ↑ 2.0 2.1 2.2 Anderson-Peacock E, Blouin JS, Bryans R; et al. (2005). "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash" (PDF). J Can Chiropr Assoc. 49 (3): 158–209.
     • Anderson-Peacock E, Bryans B, Descarreaux M; et al. (2008). "A clinical practice guideline update from The CCA•CFCREAB-CPG" (PDF). J Can Chiropr Assoc. 52 (1): 7–8.
  3. ↑ Thiel HW, Bolton JE, Docherty S, Portlock JC (2007). "Safety of chiropractic manipulation of the cervical spine: a prospective national survey". Spine. 32 (21): 2375–8. PMID 17906581.
  4. ↑ Ernst E (2007). "Adverse effects of spinal manipulation: a systematic review". J R Soc Med. 100 (7): 330–8. PMID 17606755.
  5. ↑ Vohra S, Johnston BC, Cramer K, Humphreys K (2007). "Adverse events associated with pediatric spinal manipulation: a systematic review". Pediatrics. 119 (1): e275–83. doi:10.1542/peds.2006-1392. PMID 17178922.
  6. ↑ Hurwitz EL, Carragee EJ, van der Velde G; et al. (2008). "Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders". Spine. 33 (4 Suppl): S123–52. doi:10.1097/BRS.0b013e3181644b1d. PMID 18204386.
Retrieved from "https://www.wikidoc.org/index.php?title=Chiropractic_-_Safety&oldid=570852"