Chiropractic neck manipulations risk to public, says report

Manitoba health professionals who perform the common chiropractic treatment known as "high neck manipulations" should be required to explain the risks to patients — and tell them how to detect a bad reaction — before getting consent.

Those are the core recommendations in a report presented to Health Minister Kelvin Goertzen last spring by the province's Health Professions Advisory Council. The report was made public earlier this week.

Last year, the minister directed the advisory council to review the use of cervical spine manipulations, a procedure that is among the 21 reserved acts that only authorized health professionals can administer.

The advisory council chair and main report author, Neil Duboff, concluded that while his team did not find conclusive evidence that should cause the procedure to be banned, it did find that "cervical spine manipulation does present a risk of harm to patients. This risk of harm must be understood by both the patient and the practitioner."

Input was sought from the regulatory bodies for chiropractors, physiotherapists, naturopaths, osteopaths and physicians. A written submission was also provided by the advocacy group Manitoba Chiropractic Stroke Survivors.

The report states that the College of Physicians and Surgeons of Manitoba (CPSM) had "serious reservations" about chiropractors having authority to perform manipulations of the spine in general.

"The CPSM believes the [Manitoba Chiropractors Association] should be required to demonstrate scientifically the safety and efficacy of spinal manipulation therapy to ensure patient safety," the report states.

The CPSM provided the authors with records they say demonstrates an association between spinal manipulations and adverse events such as fractured vertebrae, spinal cord injury and strokes. The CPSM did not, it is however noted, express an opinion about the use of spinal manipulations by its own members.

'Key component of chiropractic practice'

In their submission, the Manitoba Chiropractors Association (MCA) estimated close to 99 per cent of their members perform these manipulations on a daily basis based on a 2009 survey and called it a "key component of chiropractic practice."

The Advisory Council notes in its report that the MCA provided four publications which outlined the benefits of spinal adjustment for targeting neck pain and headaches.

However, the report's authors note that "in reviewing the publications, the Council is not certain that these publications are demonstratively supportive of the MCA's position as comparisons are made only with exercise and massage and not other standard treatments such as over-the-counter pain medication."

In one case, the authors noted that "the studies the MCA relies on to support its position are not as emphatic in their conclusions as the MCA suggests."

The report notes that the MCA's standard of practice already requires its members to obtain written informed consent from the patient and to disclose and discuss "potential risks" and benefits. However, the authors highlight that there is inconsistency in the use of language — other policies require only the disclosure of what is considered "significant risks" — could lead to confusion about what needs to be disclosed to patients.

The College of Physiotherapists of Manitoba wrote in their submission that while spinal manipulations is taught in their education programs, very few of their members use this treatment method due the lack of evidence to properly evaluate patient suitability.

Amy McGuinness, press secretary for the Health Minister's office, said in a statement to CBC News that final copies of the report were provided to the participating groups earlier this week.

"We will work with the relevant health profession regulatory colleges to address the findings of the council as outlined in the report," she said.

In an emailed response, the Manitoba Chiropractors Association said it "welcomes the results of the thorough government review, led by the Health Professions Advisory Council."

The Association said patient safety and informed consent have always been priorities.

"We are pleased to work with government to review and further strengthen the informed consent process for Manitobans, the statement concluded."

In a follow-up email, the MCA said: "We understand that there were a variety of comments and opinions expressed in the Advisory Council report, as you point out. However, the bottom line is that this body undertook a thorough review, weighed all information and made a recommendation to government allowing regulated health professionals to continue to help Manitobans with their chronic and acute pain."