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{"work":{"id":124464650,"created_at":"2024-10-06T01:22:06.827-07:00","from_world_paper_id":259887973,"updated_at":"2024-11-27T22:54:33.004-08:00","_data":{"publisher":"Informa UK Limited","ai_title_tag":"Evaluating Risks and Benefits of Spinal Manipulation","grobid_abstract":"Spinal manipulation: are the benefits worth the risks? 'Spinal manipulation is a form of treatment that is used occasionally by some doctors, physiotherapists and osteopaths-but, for chiropractors, it is the hallmark intervention.'","publication_date":"2007,,","publication_name":"Expert Review of Neurotherapeutics","grobid_abstract_attachment_id":"118684729"},"document_type":"paper","pre_hit_view_count_baseline":null,"quality":"low","language":"en","title":"Spinal manipulation: are the benefits worth the risks?","broadcastable":false,"draft":null,"has_indexable_attachment":true,"indexable":true,"seo_quality":null}}["work"]; window.loswp.workCoauthors = [51099414]; window.loswp.locale = "en"; window.loswp.countryCode = "SG"; window.loswp.cwvAbTestBucket = ""; window.loswp.designVariant = "ds_vanilla"; window.loswp.fullPageMobileSutdModalVariant = "control"; window.loswp.useOptimizedScribd4genScript = false; window.loginModal = {}; window.loginModal.appleClientId = 'edu.academia.applesignon'; window.userInChina = "false";</script><script defer="" src="https://accounts.google.com/gsi/client"></script><div class="ds-loswp-container"><div class="ds-work-card--grid-container"><div class="ds-work-card--container js-loswp-work-card"><div class="ds-work-card--cover"><div class="ds-work-cover--wrapper"><div class="ds-work-cover--container"><button class="ds-work-cover--clickable js-swp-download-button" data-signup-modal="{"location":"swp-splash-paper-cover","attachmentId":118684729,"attachmentType":"pdf"}"><img alt="First page of “Spinal manipulation: are the benefits worth the risks?”" class="ds-work-cover--cover-thumbnail" src="https://0.academia-photos.com/attachment_thumbnails/118684729/mini_magick20241006-1-gjgrf7.png?1728202992" /><img alt="PDF Icon" class="ds-work-cover--file-icon" src="//a.academia-assets.com/images/single_work_splash/adobe_icon.svg" /><div class="ds-work-cover--hover-container"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span><p>Download Free PDF</p></div><div class="ds-work-cover--ribbon-container">Download Free PDF</div><div class="ds-work-cover--ribbon-triangle"></div></button></div></div></div><div class="ds-work-card--work-information"><h1 class="ds-work-card--work-title">Spinal manipulation: are the benefits worth the risks?</h1><div class="ds-work-card--work-authors ds-work-card--detail"><a class="ds-work-card--author js-wsj-grid-card-author ds2-5-body-md ds2-5-body-link" data-author-id="51099414" href="https://independent.academia.edu/EErnst2"><img alt="Profile image of edzard E Ernst" class="ds-work-card--author-avatar" src="https://0.academia-photos.com/51099414/29805531/27693562/s65_edzard.ernst.jpg" />edzard E Ernst</a></div><div class="ds-work-card--detail"><p class="ds-work-card--detail ds2-5-body-sm">2007, Expert Review of Neurotherapeutics</p><div class="ds-work-card--work-metadata"><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">visibility</span><p class="ds2-5-body-sm" id="work-metadata-view-count">…</p></div><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">description</span><p class="ds2-5-body-sm">2 pages</p></div><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">link</span><p class="ds2-5-body-sm">1 file</p></div></div><script>(async () => { const workId = 124464650; 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if (!viewCountBody) { throw new Error('Failed to find work views element'); } viewCountBody.textContent = `${commaizedViewCount} views`; } catch (error) { // Remove the whole views element if there was some issue parsing. document.getElementById('work-metadata-view-count')?.parentNode?.remove(); throw new Error(`Failed to parse view count: ${viewCount}`, error); } }; // If the DOM is still loading, wait for it to be ready before updating the view count. if (document.readyState === "loading") { document.addEventListener('DOMContentLoaded', () => { updateViewCount(viewCount); }); // Otherwise, just update it immediately. } else { updateViewCount(viewCount); } })();</script></div><p class="ds-work-card--work-abstract ds-work-card--detail ds2-5-body-md">Spinal manipulation: are the benefits worth the risks? 'Spinal manipulation is a form of treatment that is used occasionally by some doctors, physiotherapists and osteopaths-but, for chiropractors, it is the hallmark intervention.'</p><div class="ds-work-card--button-container"><div class="primary-buttons "><button class="ds2-5-button js-swp-download-button" data-signup-modal="{"location":"continue-reading-button--work-card","attachmentId":118684729,"attachmentType":"pdf","workUrl":"https://www.academia.edu/124464650/Spinal_manipulation_are_the_benefits_worth_the_risks"}"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">description</span>See full PDF</button><button class="ds2-5-button ds2-5-button--secondary js-swp-download-button" data-signup-modal="{"location":"download-pdf-button--work-card","attachmentId":118684729,"attachmentType":"pdf","workUrl":"https://www.academia.edu/124464650/Spinal_manipulation_are_the_benefits_worth_the_risks"}"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span>Download PDF</button></div></div><div class="ds-signup-banner-trigger-container"><div class="ds-signup-banner-trigger ds-signup-banner-trigger-control"></div></div><div class="ds-signup-banner ds-signup-banner-control"><div id="ds-signup-banner-close-button"><button class="ds2-5-button ds2-5-button--secondary ds2-5-button--inverse"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">close</span></button></div><div class="ds-signup-banner-ctas" data-impression-entity-id="124464650" data-impression-entity-type="2" data-impression-source="signup-banner"><img src="//a.academia-assets.com/images/academia-logo-capital-white.svg" /><h4 class="ds2-5-heading-serif-sm">Sign up for access to the world's latest research</h4><button class="ds2-5-button ds2-5-button--inverse ds2-5-button--full-width js-swp-download-button" data-signup-modal="{"location":"signup-banner"}">Sign up for free<span class="material-symbols-outlined" style="font-size: 20px" translate="no">arrow_forward</span></button></div><div class="ds-signup-banner-divider"></div><div class="ds-signup-banner-reasons"><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Get notified about relevant papers</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Save papers to use in your research</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Join the discussion with peers</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Track your impact</span></div></div></div><script>(() => { // Set up signup banner show/hide behavior: // 1. 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Appropriate use of spinal manipulation provided by a chiropractor can be helpful in treating mechanical-type back pain, but there are good reasons to avoid chiropractic manipulation based on correction of " vertebral subluxations, " and there are red flags to look for before undergoing any kind of manipulative treatment for neck or back pain.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Chiropractic and Spinal Manipulation Red Flags: A Comprehensive Review","attachmentId":53873008,"attachmentType":"doc","work_url":"https://www.academia.edu/33900569/Chiropractic_and_Spinal_Manipulation_Red_Flags_A_Comprehensive_Review","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/33900569/Chiropractic_and_Spinal_Manipulation_Red_Flags_A_Comprehensive_Review"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="1" data-entity-id="7657887" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/7657887/The_basis_for_spinal_manipulation_Chiropractic_perspective_of_indications_and_theory">The basis for spinal manipulation: Chiropractic perspective of indications and theory</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="13888357" href="https://lifewest.academia.edu/CharlesHenderson">Charles N R Henderson</a></div><p class="ds-related-work--abstract ds2-5-body-sm">It is reasonable to think that patients responding to spinal manipulation (SM), a mechanically based therapy, would have mechanical derangement of the spine as a critical causal component in the mechanism of their condition. Consequently, SM practitioners routinely assess intervertebral motion, and treat patients on the basis of those assessments.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"The basis for spinal manipulation: Chiropractic perspective of indications and theory","attachmentId":34195692,"attachmentType":"pdf","work_url":"https://www.academia.edu/7657887/The_basis_for_spinal_manipulation_Chiropractic_perspective_of_indications_and_theory","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/7657887/The_basis_for_spinal_manipulation_Chiropractic_perspective_of_indications_and_theory"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="2" data-entity-id="66504714" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/66504714/Risks_associated_with_spinal_manipulation">Risks associated with spinal manipulation</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="51099414" href="https://independent.academia.edu/EErnst2">edzard E Ernst</a></div><p class="ds-related-work--metadata ds2-5-body-xs">The American Journal of Medicine, 2002</p><p class="ds-related-work--abstract ds2-5-body-sm">To summarise the evidence about the risks of spinal manipulation. Searching MEDLINE (via PubMed), EMBASE, and the Cochrane Library were searched in November 2001 (start dates not given) for articles in any language. The search terms used were 'adverse effects', 'adverse events', 'chiropractic', 'complications', 'manual therapy', 'osteopathy', 'risk', 'safety', 'spinal manipulation', 'stroke', and 'vascular accident'. Reference lists and the authors' own files were handsearched, and other experts (n=9) were consulted. Study selection Study designs of evaluations included in the review Any report containing data about the risks associated with spinal manipulation was included. Recent systematic reviews were used as the basis of the article. Specific interventions included in the review The specific intervention was spinal manipulation. Participants included in the review Patients of all ages who were receiving spinal manipulation were included. Outcomes assessed in the review The nature and incidence of adverse events was assessed. How were decisions on the relevance of primary studies made? The authors do not state how the papers were selected for the review, or how many of the reviewers performed the selection. How were differences between studies investigated? The authors do not report a method for investigating heterogeneity between the studies. Results of the review Systematic reviews (1), comprehensive reviews (2), case-control studies (1), case reports and case series (27), and</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Risks associated with spinal manipulation","attachmentId":77670842,"attachmentType":"pdf","work_url":"https://www.academia.edu/66504714/Risks_associated_with_spinal_manipulation","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/66504714/Risks_associated_with_spinal_manipulation"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="3" data-entity-id="14943262" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/14943262/Review_conclusions_by_Ernst_and_Canter_regarding_spinal_manipulation_refuted">Review conclusions by Ernst and Canter regarding spinal manipulation refuted</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="33934374" href="https://independent.academia.edu/MitchellHaas">Mitchell Haas</a><span>, </span><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="21461504" href="https://independent.academia.edu/AnthonyRosner">Anthony Rosner</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Chiropractic & osteopathy, 2006</p><p class="ds-related-work--abstract ds2-5-body-sm">In the April 2006 issue of the Journal of Royal Society of Medicine, Ernst and Canter authored a review of the most recent systematic reviews on the effectiveness of spinal manipulation for any condition. The authors concluded that, except for back pain, spinal manipulation is not an effective intervention for any condition and, because of potential side effects, cannot be recommended for use at all in clinical practice. Based on a critical appraisal of their review, the authors of this commentary seriously challenge the conclusions by Ernst and Canter, who did not adhere to standard systematic review methodology, thus threatening the validity of their conclusions. There was no systematic assessment of the literature pertaining to the hazards of manipulation, including comparison to other therapies. Hence, their claim that the risks of manipulation outweigh the benefits, and thus spinal manipulation cannot be recommended as treatment for any condition, was not supported by the data ...</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Review conclusions by Ernst and Canter regarding spinal manipulation refuted","attachmentId":43721311,"attachmentType":"pdf","work_url":"https://www.academia.edu/14943262/Review_conclusions_by_Ernst_and_Canter_regarding_spinal_manipulation_refuted","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/14943262/Review_conclusions_by_Ernst_and_Canter_regarding_spinal_manipulation_refuted"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="4" data-entity-id="9291283" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/9291283/Why_do_spinal_manipulation_techniques_take_the_form_they_do_Towards_a_general_model_of_spinal_manipulation">Why do spinal manipulation techniques take the form they do? Towards a general model of spinal manipulation.</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="232981" href="https://bso.academia.edu/DavidEvans">David Evans</a></div><p class="ds-related-work--abstract ds2-5-body-sm">For centuries, techniques used to manipulate joints in the spine have been passed down from one generation of manipulators to the next. Today, spinal manipulation is in the curious position that positive clinical effects have now been demonstrated, yet the theoretical base underpinning every aspect of its use is still underdeveloped. An important question is posed in this masterclass: why do spinal manipulation techniques take the form they do? From the available literature, two factors appear to provide an answer: 1. Action of a force upon vertebrae. Any 'direct' spinal manipulation technique requires that the patient be orientated in such a way that force is applied perpendicular to the overlying skin surface so as to act upon the vertebrae beneath. If the vertebral motion produced by 'directly' applied force is insufficient to produce the desired effect (e.g. cavitation), then force must be applied 'indirectly', often through remote body segments such as the head, thorax, abdomen, pelvis, and extremities. 2. Spinal segment morphology. A new hypothesis is presented. Spinal manipulation techniques exploit the morphology of vertebrae by inducing rotation at a spinal segment, about an axis that is always parallel to the articular surfaces of the constituent zygapophysial joints. In doing so, the articular surfaces of one zygapophysial joint appose to the point of contact, resulting in migration of the axis of rotation towards these contacting surfaces, and in turn this facilitates gapping of the other (target) zygapophysial joint. Other variations in the form of spinal manipulation techniques are likely to depend upon the personal style and individual choices of the practitioner.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Why do spinal manipulation techniques take the form they do? Towards a general model of spinal manipulation.","attachmentId":35553565,"attachmentType":"pdf","work_url":"https://www.academia.edu/9291283/Why_do_spinal_manipulation_techniques_take_the_form_they_do_Towards_a_general_model_of_spinal_manipulation","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/9291283/Why_do_spinal_manipulation_techniques_take_the_form_they_do_Towards_a_general_model_of_spinal_manipulation"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="5" data-entity-id="66505589" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/66505589/Chiropractic_spinal_manipulation_what_does_the_best_evidence_show">Chiropractic spinal manipulation: what does the ‘best’ evidence show?</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="51099414" href="https://independent.academia.edu/EErnst2">edzard E Ernst</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Focus on Alternative and Complementary Therapies, 2012</p><p class="ds-related-work--abstract ds2-5-body-sm">Background The evidence of effectiveness of chiropractic is controversial. Objectives To summarise all Cochrane reviews of chiropractic spinal manipulation. Methods The Cochrane database was searched for all Cochrane reviews of chiropractic manipulation. Cochrane reviews with the terms 'chiropractic', 'manipulation' or 'manual therapy' in the title, abstract or keywords were considered. Protocols of reviews were excluded, as were studies that did not focus specifically on chiropractic spinal manipulation. Data extraction was performed by the author according to predefined criteria. Results Five Cochrane reviews were eligible for inclusion. Due to clinical and statistical heterogeneity, a meta-analysis was not possible and the findings of the reviews were discussed narratively. The five reviews related to the following conditions: low back pain, asthma, dysmenorrhoea and neck pain. Each review included between three and 39 primary studies. Cautiously positive conclusions emerged for low back pain and neck pain. For the two non-spinal conditions, the conclusions were negative. Conclusions Cochrane reviews, generally considered to be the most reliable evidence, provide limited evidence that chiropractic may be effective for low back and neck pain, but failed to support the use of chiropractic for non-spinal conditions.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Chiropractic spinal manipulation: what does the ‘best’ evidence show?","attachmentId":77671321,"attachmentType":"pdf","work_url":"https://www.academia.edu/66505589/Chiropractic_spinal_manipulation_what_does_the_best_evidence_show","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/66505589/Chiropractic_spinal_manipulation_what_does_the_best_evidence_show"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="6" data-entity-id="96252495" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/96252495/Chiropractic_Care_Concerns_and_Cautions_Spinal_Manipulation_and_Subluxation_Nonsense">Chiropractic Care: Concerns & Cautions Spinal Manipulation and Subluxation Nonsense</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="32265969" href="https://independent.academia.edu/SamuelHomola">Samuel Homola</a></div><p class="ds-related-work--abstract ds2-5-body-sm">While chiropractors do a good job treating mechanical-type back pain, there are good reasons to be skeptical about chiropractic manipulation based on correction of "vertebral subluxations." There is evidence to indicate that spinal manipulation can be helpful in treating some types of back pain, but chiropractic care is based upon an unproven and implausible subluxation theory suggesting that many organic ailments can be treated by adjusting vertebral subluxations. A grain of truth mixed with subluxation nonsense makes it difficult for most of us to distinguish between appropriate and inappropriate use of manipulation by chiropractors.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Chiropractic Care: Concerns \u0026 Cautions Spinal Manipulation and Subluxation Nonsense","attachmentId":98202809,"attachmentType":"doc","work_url":"https://www.academia.edu/96252495/Chiropractic_Care_Concerns_and_Cautions_Spinal_Manipulation_and_Subluxation_Nonsense","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/96252495/Chiropractic_Care_Concerns_and_Cautions_Spinal_Manipulation_and_Subluxation_Nonsense"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="7" data-entity-id="20911240" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/20911240/A_perspective_for_considering_the_risks_and_benefits_of_spinal_manipulation_in_patients_with_low_back_pain">A perspective for considering the risks and benefits of spinal manipulation in patients with low back pain</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="42191437" href="https://baylor.academia.edu/JChilds">John D Childs</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Manual therapy, 2006</p><p class="ds-related-work--abstract ds2-5-body-sm">The purpose of this study was to determine if patients who do not receive manipulation for their low back pain (LBP) are at an increased risk for worsening disability compared to patients receiving an exercise intervention without manipulation. One hundred and thirty-one consecutive patients with LBP were randomly assigned to receive manipulation and an exercise intervention (n = 70) or an exercise intervention without manipulation (n = 61). Patients were classified as to whether they had experienced a worsening in disability upon follow-up. Relative risk and number needed to treat (NNT) statistics and associated 95% confidence intervals (CI) were calculated. Patients who completed the exercise intervention without manipulation were eight (95% CI: 1.1, 63.5) times more likely to experience a worsening in disability than patients who received manipulation. The NNT with manipulation to prevent one additional patient from experiencing a worsening in disability was 9.9 (95% CI: 4.9, 65....</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"A perspective for considering the risks and benefits of spinal manipulation in patients with low back pain","attachmentId":41624971,"attachmentType":"pdf","work_url":"https://www.academia.edu/20911240/A_perspective_for_considering_the_risks_and_benefits_of_spinal_manipulation_in_patients_with_low_back_pain","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/20911240/A_perspective_for_considering_the_risks_and_benefits_of_spinal_manipulation_in_patients_with_low_back_pain"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="8" data-entity-id="105745710" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/105745710/Adverse_effects_of_spinal_manipulation_a_systematic_review">Adverse effects of spinal manipulation: a systematic review</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="51099414" href="https://independent.academia.edu/EErnst2">edzard E Ernst</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Journal of the Royal Society of Medicine, 2007</p><p class="ds-related-work--abstract ds2-5-body-sm">Objective To identify adverse effects of spinal manipulation. Design Systematic review of papers published since 2001. Setting Six electronic databases. Main outcome measures Reports of adverse effects published between January 2001 and June 2006. There were no restrictions according to language of publication or research design of the reports. Results The searches identified 32 case reports, four case series, two prospective series, three case-control studies and three surveys. In case reports or case series, more than 200 patients were suspected to have been seriously harmed. The most common serious adverse effects were due to vertebral artery dissections. The two prospective reports suggested that relatively mild adverse effects occur in 30% to 61% of all patients. The case-control studies suggested a causal relationship between spinal manipulation and the adverse effect. The survey data indicated that even serious adverse effects are rarely reported in the medical literature. Conclusions Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Adverse effects of spinal manipulation: a systematic review","attachmentId":105128104,"attachmentType":"pdf","work_url":"https://www.academia.edu/105745710/Adverse_effects_of_spinal_manipulation_a_systematic_review","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/105745710/Adverse_effects_of_spinal_manipulation_a_systematic_review"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="9" data-entity-id="29466183" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/29466183/A_replication_of_the_study_Adverse_effects_of_spinal_manipulation_a_systematic_review">A replication of the study 'Adverse effects of spinal manipulation: a systematic review</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="55541890" href="https://independent.academia.edu/PeterTuchin">Peter Tuchin</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Chiropractic & manual therapies, 2012</p><p class="ds-related-work--abstract ds2-5-body-sm">To assess the significance of adverse events after spinal manipulation therapy (SMT) by replicating and critically reviewing a paper commonly cited when reviewing adverse events of SMT as reported by Ernst (J Roy Soc Med 100:330-338, 2007). Replication of a 2007 Ernst paper to compare the details recorded in this paper to the original source material. Specific items that were assessed included the time lapse between treatment and the adverse event, and the recording of other significant risk factors such as diabetes, hyperhomocysteinemia, use of oral contraceptive pill, any history of hypertension, atherosclerosis and migraine. The review of the 32 papers discussed by Ernst found numerous errors or inconsistencies from the original case reports and case series. These errors included alteration of the age or sex of the patient, and omission or misrepresentation of the long term response of the patient to the adverse event. Other errors included incorrectly assigning spinal manipulati...</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"A replication of the study 'Adverse effects of spinal manipulation: a systematic review","attachmentId":49909209,"attachmentType":"pdf","work_url":"https://www.academia.edu/29466183/A_replication_of_the_study_Adverse_effects_of_spinal_manipulation_a_systematic_review","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/29466183/A_replication_of_the_study_Adverse_effects_of_spinal_manipulation_a_systematic_review"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div></div></div><div class="ds-sticky-ctas--wrapper js-loswp-sticky-ctas hidden"><div class="ds-sticky-ctas--grid-container"><div class="ds-sticky-ctas--container"><button class="ds2-5-button js-swp-download-button" data-signup-modal="{"location":"continue-reading-button--sticky-ctas","attachmentId":118684729,"attachmentType":"pdf","workUrl":null}">See full PDF</button><button class="ds2-5-button ds2-5-button--secondary js-swp-download-button" data-signup-modal="{"location":"download-pdf-button--sticky-ctas","attachmentId":118684729,"attachmentType":"pdf","workUrl":null}"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span>Download PDF</button></div></div></div><div class="ds-below-fold--grid-container"><div class="ds-work--container js-loswp-embedded-document"><div class="attachment_preview" data-attachment="Attachment_118684729" style="display: none"><div class="js-scribd-document-container"><div class="scribd--document-loading js-scribd-document-loader" style="display: block;"><img alt="Loading..." src="//a.academia-assets.com/images/loaders/paper-load.gif" /><p>Loading Preview</p></div></div><div style="text-align: center;"><div class="scribd--no-preview-alert js-preview-unavailable"><p>Sorry, preview is currently unavailable. 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