When it comes to manipulation, appearances can be deceiving. Manipulation is thought to be a simple, quick, noninvasive and easy procedure to perform. However, it is not without risk and can provoke central neurovascular problems with injury to the vertebral artery or vertebrobasilar trunk. The pathology most often incriminated is that of vertebral artery dissection.
The medical and chiropractic literature have proposed several hypotheses concerning the physiologic effects of manipulation and mobilization, which has lead to different treatment concepts (Mennell 1949, Maitland 1980, Sohier 1970, Cyriax 1971; Lewitt 1991). Despite these advancement, none have proven superior to another; none of these techniques have been properly evaluated concerning vascular complications.
There are no epidemiological studies which allow us to measure the incidence of vascular complications. The estimates vary between 1/40,000 and 1/2,000,000, depending on the authors and the types of complications (Guttman 1983, Dvorak & Orelli 1985, Terett 1987). The manipulative techniques in question are seldom described.
The value of the predictive tests are highly argued (Thiel 1994). Some of them provoke the complications that they're supposed to predict and avoid (Laedermann 1990).
The mechanisms at the origin of these vascular results are not well known; even some activities of everyday life are prone to provoke this type of accident. In most cases studied, it is not possible to find any element that could have triggered the dissection. Some authors argue that a classification which artificially attempts to distinguishes between spontaneous dissections and those induced by microtrauma (Duche 1986), among which manipulation is sometimes categorized, is unjustified.
The goal of this conference is to evaluate what is know about:
- The efficacy of vertebral manipulation in cases of cervical spine dysfunction (Drs. Vernon and Fitz-Ritson).
- The minor secondary effects and the complications occurring after cervical manipulation, and their underlying mechanisms (Drs. Leboeuf, Triano, Hutkins, Kraenzlin, and Lefloch).
- The incidence and the risk factors leading to these complications and the methodology to evaluate them (Drs. Haldeman, Rosner, and Morabia).
- The validity of the predictive tests and preventative strategies (Drs. Gerard, and Sturzenegger).
There will also be a multi-technique symposium, similar to those held by the ACA Council on Technic. This symposium is designed to identify and describe therapeutic procedures belonging to currently used techniques (Diversified, S.O.T., Nimmo, A.K.) said to be useful in cervical treatment. The symposium will also illustrate these procedures in relation to the theories and rationales underlying the proposed procedures.
The association of cervical trauma with manual cervical techniques has long been controversial, and the goal of the multidisciplinary conference is to explore and put in proper perspective this highly debated subject using the best clinical and scientific information available.
The conference will include presentations and discussions by clinicians and researchers to illuminate the role of cervical manual techniques. There will be hands-on workshops to illustrate the rationale of various techniques. Scheduled speakers include:
- Kevin Bartol, DC, associate professor, Northwestern College of Chiropractic, Bloomington, Minnesota;
- Donald Fitz-Ritson, DC, head of International Managed Health Care, Toronto, Canada;
- Dr. Gerard, MD, head of Headache and Neurology Center of Ohio;
- Scott Haldeman, DC, MD, PhD, neurology consultant; chairman, World Federation of Chiropractic;
- Professor Hutkins, PhD, DSc, research department of bio-medical physics and bioengineering, Aberdeen University;
- Charlotte Leboeuf, DC, MPH, research department, Nordic Institute for Chiropractic and Clinical Biomechanics;
- Anthony Rosner, PhD, research director, Foundation for Chiropractic Education and Research (FCER);
- John Triano, DC, PhD, research director, Texas Back Institute;
- Howard Vernon, DC, research director, Canadian Memorial College of Chiropractic, Toronto, Canada.
The conference will be attended by members of diverse disciplines and will unite clinicians and researchers from various horizons to continue the cooperation between chiropractic, medical, and other health professions.
For further information on the ECU annual convention, contact the conference secretary, Jacqueline Robert, DC, at:
2 rue Saint-Leger
1205 Geneva
Switzerland
Tel. (from the US) 011 41 22 320 28 21
Fax (from the US) 011 41 22 320 25 23
The convention will be held at the President's Hotel in Geneva. The hotel may be contacted at:
President's Hotel
Quai Wilson 47
1211 Geneva
Switzerland
Tel. (from the US) 011 41 22 731 10 00
Fax (from the US) 011 41 22 731 22 06
Bibliography
Bogduk N. Neck pain: how to treat? Australian Dr. Weekly, Aug. 21, 1992, I-VI.
Cassidy JD, Lopes AA, et al. Immediate effect of manipulation versus mobilization on pain and ROM in cervical spine: a randomized clinical trial. JMPT 1992, 15:570-575.
Cyriax J. Textbook of Orthopaedic Medicine, 8th edition. London, Bailliere Tindall, 1971.
Duche B. Dissection spontanee des arteres cervico-cerebrales: analyse de 52 cas et revue de la litterature. These pour le Doctorat en Medecine, 1986, Univ. de Bordeaux.
Dvorak J, Orelli F. How dangerous is manipulation of the cervical spine? Manual Medicine 1985, 2:1-4.
Fitz-Ritson D. Chiropractic management and rehabilitation of cervical trauma. JMPT 1990, 13:17-25.
Guttman G. Injuries to the vertebral artery caused by manual therapy. Manuelle Medizin 1983, 21:2-14.
Laedermann JP. Cerebrovascular accidents related to chiropractic care; further considerations. Euro J of Chiro 1990, 38:63-68.
Lewitt K. Manipulative Therapy in Rehabilitation of the Locomotor System, 2nd. edition. Oxford, Butterwords-Heinemann, 1991. Maitland GD. Vertebral Manipulation, 4th ed. London, Butterworths, 1980.
Mealy K, et al. Early mobilisation of acute whiplash injuries. BMJ 1986, 293:656-657.
Mennell JB. The Science and Art of Joint Manipulation in Spinal Column, Vol. 2. London, J.A. Churchill, 1949.
Parker GB, et al. A controlled trial of cervical manipulation for migraine. Aust NZ J Med 1978, 8:589-593.
Parker GB, et al. Why does migraine improve during a clinical trial? Further results from a trial of cervical manipulation for migraine. Aust NZ J Med 1980, 10:192-198.
Sohier R. Kinesitherapie analytique de la colonne vertebrale. La Louvriere: Kine-Sciences, 1970.
Thiel H, et al. Effect of various head and neck positions on vertebral artery blood flow. Clin Biomech 1994, 9:105-110.
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