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Excerpt
It now is essential that research be conducted in areas other than comparative efficacy trials. The potential side effects, complications, contraindications, and idiosyncrasies of spinal manipulation need to be studied so that a more realistic comparison between therapeutic approaches can be made and so that positive and negative responses of patients can be anticipated.
The research by Senstad et al represents the first time that common side effects and symptom provocation from routine spinal manipulation or chiropractic practice has been described in a quantitative fashion. Many of these complaints are well known to practitioners who use spinal manipulation, but their frequency and duration never have been documented.
It is comforting to note that there were no permanent complications experienced by more than 1000 new patients and after 4712 treatment sessions. The authors do not suggest that these side effects would be a contraindication to manipulation but that they should be understood and even expected. The rare case of vertebrobasilar artery compromise and even rarer cauda equina syndrome after spinal manipulation should not, however, be ignored because these complications can result in serious permanent deficits.
It is fairly easy to explain why certain individuals may experience local or radiating discomfort after manipulation because a mechanical force often is applied to a painful area of the spine during the procedure. It is, however, more difficult to explain why people would have systemic symptoms, such as tiredness, nausea, hot or prickly skin, or, as other authors (quoted in this article) have noted, tremor, diarrhea, palpitations, and heavy menstruation. This report raises the possibility of a visceral or systemic effect or at least a psychophysiologic response to manipulation.
As spinal manipulation becomes even more of a mainstream therapeutic approach for patients with spinal disorders, we should expect that its practitioners will continue to explore not only the value of their method of treatment but also the side effects. It would also be of interest to begin investigating the mechanisms of these responses. Similar research should, at the same time, be encouraged from practitioners of other nonsurgical approaches, especially if they hope to see their preferred treatment modality reach the level of acceptance achieved by spinal manipulation. It always should be kept in mind that there is no totally benign treatment for patients with spinal disorders. There is, however, extensive ignorance of the frequency and severity of complications for many treatment methods. This article helps to reduce the ignorance about the responses that can be anticipated in patients undergoing spinal manipulation.
