Paper
Manipulative therapy and physiotherapy for persistent back and neck complaints.
Published 1992 · P. Brien, M. J. Brien
BMJ
7
Citations
0
Influential Citations
Abstract
SIR, —Bart W Koes and colleagues have shown the benefits of manipulative therapy compared with physiotherapy,' supporting the findings of an earlier trial conducted by the Medical Research Council.' Firstly, however, contrary to the statement in their paper, it is not possible to differentiate patients with disc herniation from those with other causes of back pain on the basis of a non-specific complaint and physical examination. Radiological investigations such as computed tomography, mvelography, and magnetic resonance imaging are usually required to achieve this distinction. Secondly, intervertebral discs start to degenerate in early adulthood, becoming symptomatic after fragmentation, with herniation through an intact annulus or impingement on the spinal canal.' As manipulative therapy entails small movements of high velocity, applying sudden stresses to chronically degenerating discs may precipitate protrusion of a disc. Manipulating the spines of patients with back pain of undiagnosed aetiology is not without risk, and known complications, although rare, range from injury to the cervical cord' to brain stem infarction.' Our experience includes two cases of compression of the cauda equina after chiropractic manipulation° in which the diagnosis was delayed, resulting in long term disability . As a result we endorse calls for further trials to elucidate the role of spinal manipulation in the management of low back pain and for a review of chiropractic training in the United Kingdom. '
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