Safety
The safe application of spinal manipulation requires a thorough medical history, assessment, diagnosis and plan of management. Manipulative therapists, including chiropractors, must rule out contraindications to HVLA spinal manipulative techniques. Absolute contraindications refers to diagnoses and conditions that put the patient at risk to developing adverse events. For example, a diagnosis of rheumatoid arthritis and other conditions that structurally destabilizes joints, is an absolute contraindication of SMT to the upper cervical spine. Relative contraindications, such as osteoporosis are conditions where increased risk is acceptable in some situations and where mobilization and soft-tissue techniques would be treatments of choice. Most contraindication apply only to the manipulation of the affected region.
Adverse events in spinal manipulation studies are believed to be under-reported and appear to be more common following HVLA manipulation than mobilization. Mild, frequent and temporary adverse events occur in SMT which include temporary increase in pain, tenderness and stiffness. These events typically dissipates within 24–48 hours Serious injuries and fatal consequences, especially to SM in the upper cervical region, can occur. but are regarded as rare when spinal manipulation is employed skillfully and appropriately.
There is considerable debate regarding the relationship of spinal manipulation to the upper cervical spine and stroke. Stroke is statistically associated with both general practitioner and chiropractic services in persons under 45 years of age suggesting that these associations are likely explained by preexisting conditions. Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke. A 2012 systematic review determined that there is insufficient evidence to support a strong association or no association between cervical manipulation and stroke.
Read more about this topic: Chiropractic Treatment Techniques
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