From the Research
Indications for Cervical Spinal Manipulation (CSM)
The clear indications for maximum benefit from cervical spinal manipulation (CSM) include:
- Non-specific mechanical neck pain 1, 2
- Cervicogenic headache 1
- Tension-type headache 2
- Neck pain and muscle-tension headache 3
- Cervical radiculopathy, as part of a nonoperative management plan 4
Conditions for Safe CSM
To minimize risks and maximize benefits, CSM should be performed:
- By experienced physicians or physical therapists 1, 3
- With a thorough physical examination, including a neurological evaluation, prior to manipulation 1
- With caution, especially during first-line cervical manipulation 1
- After obtaining informed consent, including information about potential risks 1, 3
Benefits and Risks of CSM
The benefits of CSM include:
- Short-term relief for patients with neck pain and headaches 2
- Improvement in pain status for patients with subacute or chronic neck pain 2 The risks of CSM include:
- Severe neurologic complications, although rare and generally unpredictable 1, 3
- Vertebral artery damage, which can be avoided with the use of mobilization (nonthrust passive movements) 3
- Arterial dissection or spasm, and lesions of the brain stem 3