Finally it seems that the APA are acknowledging that cervical spine manipulation and the risks associated with it require careful pre-application and signed, informed and understood concent before a procedure is carried out. Why? Because it is a hig risk technique, it does cause harm (shown especially in the younger age group <45)
Statement of Concern to the Canadian Public from Canadian Neurologists: 2002 - A recent study by the Institute of Clinical Evaluative Sciences (ICES Ontario) indicates that patients with posterior circulation strokes under the age of 45 are 5 times more likely than controls to have visited a chiropractor within one week of the event
Physiobase welcomes the revised guidelines even though they put a dampener on one's clinical practise. Afterall in a technique where you need a client to remain relaxed this can't be you first thought: "Oh by the way their is a risk of stroke and death when I perform this technique - please sign here to say it is OK." Hmmm, maybe not.

I tend to agree that there is a lot written about the incidence of symptoms post cervical manipulation. Yet when I see my osteopath or chiropractor they never mention the risks to me and they never ask me to sign off on any informed concent. Is this because it could fundementally destroy their business? Or is it because their insurance premiums match the risk. We should be careful that we don't recommend at a national association level clinical guidelines that really relate to the risk of malpractice injury claims and the insurers ability to cover that risk. In some cases the right thing to do is increase the insurance premium for cervical manipulators, something that matches that of a chiropractor in Australia. Unfortunately this is about 5 times that of a physiotherapist and that perhaps makes some policies non-competitive. Swings and round abouts here but what it best for the profession, and the patient? Please have your say..

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