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Sunday, 11 March, 2001, 00:03 GMT
Warning over spine therapies
Chiropractors and osteopaths can subtly manipulate the spine
Treatments involving the manipulation of the upper spine may carry a small risk of serious damage, says a study just published.

Chiropractors, osteopaths and physiotherapists often try to subtly move the vertebrae of the neck and upper back to relieve stiffness and pain.

However, the study, published in the Journal of the Royal Society of Medicine, reveals a small risk of a variety of severe neurological complications in the hours after treatment.

There is indeed cause for concern

Quote from research paper
Researchers from the Department of Complementary Medicine at Exeter University sent questionnaires to 323 neurologists working at British hospitals.

It asked them to record any cases of severe neurological complications such as strokes or nerve problems which happened less than 24 hours after the patient had undergone upper spine manipulation.

Out of the 239 responses, 24 said they could recall such cases, in some instances more than one.

Severe consequences

In total, there were 35 cases which the neurologists said followed hot on the heels of spinal manipulation.

While even this many cases represents a relatively low risk, the consequences for the few affected could be serious.

One woman mentioned in the report suffered a severe stroke, leaving her with a massively swollen brain which required surgery. She was left disabled.

Another 42-year-old woman reported tingling in both hands, and was dragging her left leg after manipulation.

Neurosurgery was needed to correct the vertebrae, which had prolapsed and were compressing the spinal cord.

'More research needed'

The study authors acknowledged that, because of the nature of the questionnaire, there was no way of telling for certain whether the neurologists' memories were accurate - or whether the patients would have suffered the complications with or without spinal manipulation.

However, they are calling for more research into the issue.

They wrote: "There is indeed cause for concern... the subject requires direct investigation.

"A large and long-term prospective study is planned, in an attempt to detect all serious cases and determine the scale of the hazard."

A spokesman for the General Osteopathic Council said that profession had been self-regulated since the early 1990s so that the public could be assured anyone calling themselves an osteopath would be by law subject to stringent standards.

He said: "We have not yet seen this research, but these treatments certainly have to be done correctly.

Chiropractic is safe in skilled hands

British Chiropractic Association
"The issue of public safety and confidence is one of the major factors which influenced the profession to regulate itself."

A spokesman for the British Chiropractic Association said: "This study did not include information regarding the profession or qualifications of those carrying out the manipulations, nor why the manipulations were done.

"No neurological histories were given for the patients who experienced complications - in fact, in most cases, the information was simply recalled by respondents without reference to the patients' case notes."

"Chiropractic is safe in skilled hands, as set down in the Royal College of General Practitioners guidelines 1996 and 1999. The Association would welcome robust and thorough research into this subject in the future."

A spokesman for the Chartered Society of Physiotherapy said that there was no way of telling which sort of practitioner had been visited prior to the neurological problem.

"They assumed that the patients had seen a physiotherapist, osteopath, or chiropractor, but had no way of knowing this, nor if the practitioner had been qualified to a recognised standard.

"Previous research has reported a low risk with spinal manipulation, provided patients are selected and assessed properly, and the treatment is carried out by a trained therapist or practitioner."

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