Neck Manipulations - In Safe British Hands
by Marc Jones, DO (UK), Osteopath
May 2006
A controversial topic with some controversial comments from the author!
How safe is Osteopathy?
Osteopathy has one of the best safety records of any medically related profession, but no form of medical treatment is ever 100% safe in every case.
I have been trained to recognise any condition that might make osteopathic treatment inadvisable so that I can refer my patients for appropriate medical intervention when necessary. In the same way that a family physician regards safety as the most important factor in selecting the appropriate medication for a particular patient, I also select the most appropriate style of treatment with safety as the prime consideration.
Contrary to that which some might try and lead you to believe, NO healthcare professional wants you to come to any harm.
Are there any side-effects or risks to osteopathic treatment?
Yes, but there are risks in everything that we do in life. Most of my osteopathic patients feel no reactions at all.
Common: general ache or soreness for 24-48 hours following a positive response to osteopathic treatment.
Infrequent: exacerbation of symptoms due to reaction to osteopathic treatment.
Extremely rare: serious complications requiring medical intervention.
Upper Neck (Cervical HVT or HVLA) Manipulations
This leads us neatly into 'upper neck manipulations'. A topic that at best is described as "run-of-the-mill" and at worst is likened to the "handy-work of the devil himself". As is often the case, the truth is somewhere in between and YOU have to decide whom to believe as there is no simple answer.
If someone is NOT trained and experienced, you are asking for trouble. If your practitioner (osteopath or chiropractor) REFUSES to manipulate your neck, even if they are trained and you insist upon it, then you are a liability to both yourself and your practitioner.
Neck manipulations, whether osteopathic or chiropractic, are exceptionally safe when done by trained and experienced professionals. For example, a woman in the UK has more chance of dropping dead from using the contraceptive pill than suffering a stroke (or worse) from a neck manipulation. Think about it... how many women do YOU know whom have died from using the contraceptive pill? For me, none, but I am very aware that inexperience in neck techniques can still be a liability.
Let's clear up exactly what a "stroke" is: a stroke is damage to the brain due to the interruption of its blood supply either by a small clot or a narrowing/overstretched blood vessel. Symptoms can involve headache, dizziness, confusion, visual disturbance, slurred or loss of speech, a difficulty in swallowing and, in some cases, death.
The causes of a stroke are unpredictable and can occur through sudden or extreme end of range positions. Look at the list below:
leaning your head back over a basin at the hairdressing salon
coughing
sneezing
turning your head while reversing your car
... or any of a number of other day-to-day neck movements.
The problem is this: there is no way possible for any osteopath, physician or chiropractor to predict with 100% certainty whom (if anyone) is susceptible to a stroke, just as we cannot predict which (if any) woman will suffer from using the contraceptive pill.
So how safe are osteopathic manipulations? The British health benefits (insurance) company BUPA describes osteopathy as follows: "There is a general consensus that osteopathy is less risky in terms of spinal injury because osteopaths usually use less forceful manipulation techniques on the spine."
Add the above quote from BUPA to data from North American chiropractors suggesting that 1 in every 1.46 million chiropractic neck manipulations will result in a stroke (1 in 1 million women in the UK will die from using oral contraception) and you can see how safe UK osteopaths can be... and that is not to take anything away from chiropractors and their expertise either.
So why do all the scare-mongers lay in to the North American chiropractors? For me, it is a matter of some members of the public wanting someone to blame rather than taking responsibility for their own actions and also some physicians clinging to "medical paternalism" when the world of healthcare is changing.
Experience in these matters is essential and that is where my full-time specific osteopathic training is second-to-none in North America. I know it upsets American and Canadian trained osteopaths when I say this, but if someone is going to manipulate MY upper neck I know exactly whom I want to do it (and whom not). If you haven't had a tutor breathing down your neck daily for 4 years non-stop, then you are probably not as badgered about neck manipulations as we are in Britain.
Here's my simple question to see if you are "up to the British standard": when was the last time that a practitioner whom is preparing to manipulate your neck told you about the risks, no matter how unlikely? I have to do it every day as it is a legal requirement as a GOsC osteopath and it is not very pleasant. The last time I checked, nowhere in North America does it happen.
The bottom line:
If you have any concerns about neck manipulations, you should refuse them.
If your Osteopath is concerned, he/she has the right to refuse to manipulate your neck, no matter how much of a fuss you create.
If you are concerned with ANY symptoms either before or after osteopathic treatment, see your physician.
If experienced osteopathic and chiropractic neck manipulations are as dangerous as some say, patients would be dropping like flies on a daily basis.
Make up your own mind and don't let anyone (including me) convince you of something that you are not happy with.
References and acknowledgements:
1. Australian Osteopathic Association: Is osteopathic treatment safe?
2. British Medical Association Family Medical Encyclopaedia: Stroke
3. BUPA: Fact Sheets on chiropractic and osteopathy
4. Department of Health (UK): Communication about risks to public health
5. General Chiropractic Council (UK)
6. Coulter I and others. The Appropriateness of Manipulation and Mobilization of the Cervical Spine. Santa Monica, CA: RAND, 1996, pp. 18-43.
7. K.C. Calman and G.H.D. Royston (1997): "Risk Language and Dialects" British Medical Journal 313, pp 799-802
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Copyright © Marc Jones - Osteopath (UK), Osteopathy Vancouver 2003 onwards
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