To fill this important gap in our knowledge would require collaboration between researchers from the manipulation disciplines and neurologists
Manipulation of the spine is a popular treatment which is used frequently by chiropractors. In the past 25 years, its use has been evaluated by increasingly sophisticated randomised trials. In a recent review of the emergence of the chiropractic profession from "alternative" to more "mainstream",1 the results of 20 randomised controlled trials of cervical manipulation (for migraine and tension headache, cervicogenic headache or neck pain) were described: 11 were positive, and nine equivocal. Given this supporting evidence, as well as the frequency of use of manipulation2 and the health and social impact of the conditions treated, it is important to consider any suggestions that manipulation may do more harm than good with some care.
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I have received training in spinal manipulation and have applied it clinically, but have no financial competing interests related to this subject.