From the Guidelines
Cervical spinal manipulation is recommended for patients with acute or chronic neck pain, cervicogenic headaches, and certain types of whiplash injuries, where the benefits of manipulation outweigh the risks 1.
Indications for Cervical Spinal Manipulation
- Acute or chronic neck pain
- Cervicogenic headaches
- Certain types of whiplash injuries For maximum benefit, manipulation should be performed by a licensed and experienced practitioner, and the patient should have a thorough medical evaluation to rule out contraindications such as osteoporosis, vertebral artery disease, or recent trauma 1.
Contraindications for Cervical Spinal Manipulation
- Osteoporosis
- Vertebral artery disease
- Recent trauma
- Rheumatoid arthritis
- Spinal cord compression
- Severe osteoporosis The manipulation should be gentle and controlled, with a specific focus on the affected joints and muscles, and may be combined with other therapies such as exercise, heat, or cold therapy 1.
Treatment Plan
- 6-12 sessions over 2-6 weeks
- Regular reassessment to monitor progress and adjust the treatment plan as needed It is essential to note that cervical spinal manipulation should not be performed on patients with certain medical conditions, and should be used with caution in patients taking anticoagulant medications such as warfarin or aspirin 1.
From the Research
Indications for Cervical Spinal Manipulation
The following are clear indications for cervical spinal manipulation:
- Non-specific mechanical neck pain 2
- Cervicogenic headache 2, 3, 4
- Subacute/chronic neck pain 3
- Acute/chronic neck pain with thoracic manipulation as an additional therapy 3
Benefits of Cervical Spinal Manipulation
The benefits of cervical spinal manipulation include:
- Short-term relief for patients with tension-type headache 4
- Improvement in pain and function for patients with subacute or chronic neck pain 3, 4
- Similar effects on pain, function, and patient satisfaction as mobilisation at intermediate-term follow-up 3
Risks and Precautions
The risks and precautions associated with cervical spinal manipulation include:
- Severe neurologic complications, although rare and generally unpredictable 2
- Arterial dissection or spasm, and lesions of the brain stem 5
- Vertebral artery damage, which can be avoided with the use of mobilisation (nonthrust passive movements) 5
- Importance of thorough physical examination, including a neurological evaluation, prior to manipulation 2
- Need for special caution when performing first-line cervical manipulation and informed consent 2