I admit not having read the whole article, since I’m not a member, but rather I’m going on a recent article by Dr. Steve Novella, who wrote an analysis here for the James Randi Educational Foundation.
The article in the BMJ has the conclusion neatly encapsulated in the title: “Should we abandon cervical spine manipulation for mechanical neck pain? Yes”.
Steve looks at the issue from a risk point of view, noting that all therapies can carry some risk, and the ultimately it’s a risk vs benefit analysis that must be done. He has in past written a long analysis of the issue himself here. While chiropractors have been doing the high-velocity neck manipulations for many years now, there is now emerging evidence that neck manipulation carries a risk of stroke and death from trauma to the neck arteries.
The article points out that practitioners of neck manipulation have been generally denied or minimised the possibility of harm. It is of course true that other therapies, like vaccination, also have a small risk asssociated with them – but the risk is accepted by society because of the benefits. The difference with neck manipulation is that it is now clear there is no real benefit to offset the small risk. This has been established by systematic reviews over a long period now. As with many ‘alternative therapies’, all we have are the enthusiastic claims of the practitioners, most of whom never demand evidence. They would also almost never see one of these catastrophic injuries, and therefore wrongly assess the risk. It’s the old ‘my grandfather smoked all his life and he lived to be 100‘ syndrome. Our experience is a very bad way to assess a proposition. Admittedly, the risk is quite small in absolute terms. However when viewed in a cost-benefit light, the risk is too high. As Steve puts it:
In absolute terms this is a low risk, and we certainly accept higher chances of adverse outcomes in many mainstream treatments. But we need to also consider that, while the chance may be low, the risk we are talking about is stroke or death – a very serious adverse outcome. Further, this may occur in young and otherwise healthy individuals. In that context, the risk is relative high for a medical intervention.
So, not only is there no evidence for this therapy to offset the high risk (high risk in the sense of low probability but high impact), there is no reasonable theory or method of action to support such neck manipulation. Chiropractors will tell you about so-called subluxations, which cause all manner of internal bodily illnesses. However, these continue to be imaginary. While vertabrae of the spine do often impinge on nerves to cause serious issues, the chiropractors’ claims regarding the range of illnesses caused by subluxations are fanciful. Just think about it logically for a minute: if minor (adjustable) spinal mis-alignment can cause liver problems (for example), then anyone who experiences paraplegia or quadroplegia should suffer massive organ failure, right? But they don’t. They live on in varying levels of immobility, despite suffering the mother of all subluxations. Bogus therapy – there’s no other way to put it.
So, anytime someone offers to give your head a quick whip around to relieve that headache, or stress, or digestive illness, or sore ankle, or emotional problem, JUST SAY NO.