Spinal manipulation in patients with disc herniation: A critical review of risk and benefit

Nicolas J. Snelling

The purpose of this literature review was to determine whether there is evidence from published reports on the clinical efficacy of spinal manipulation in the management of disc herniation, and to relate this to published data on harms.  There is discussion on the lack of strong evidence to support the role of spinal manipulation in disc herniation, though some weak evidence suggests it may be beneficial in the early stages. Some of the difficulties in gaining evidence on rare events and determining causality is discussed. The underlying pathophysiological mechanisms of benefit or harm are poorly understood.  The authors conclude that there is an urgent need for more research in this area in order to help practitioners make decisions on benefit versus harm. It is likely to be safe when used by appropriately-trained practitioners, however some of the reports discussed highlight the importance of a thorough case history and physical examination. It would seem reasonable that patients are warned of potential risk. They suggest that clinical guidelines on the management of disc herniation are needed, for the protection of both patients and practitioners.

International Journal of Osteopathic Medicine, Volume 9, Issue 3, September 2006, Pages 77-84

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