Manipulation is short, sharp thrust given to the spine used to remove restrictions of movement. For some back and neck pain conditions, and where contraindications are not present, spinal manipulation is supported by the scientific literature as an appropriate intervention.
Nevertheless, there are risks associated with the manoeuvre, particularly in the neck. Cases of stroke, paralysis and death have been reported secondary to neck manipulation. Although rare, the catastrophic’ness of the consequences means caution must be taken.
Children also represent a group where caution must be applied and the manipulation of their spines has recently drawn governmental attention and even controlling legislation.
The International Federation of Orthopaedic Manipulative Physical Therapists and the International Organisation of Physiotherapists in Paediatrics have recently released a joint position statement on the role (benefits and harms) of spinal manipulation and mobilisation techniques in the treatment of infants, children and adolescents.
The results of their review of the scientific literature and survey of international experts can be summarised in three definitive statements:
1) Spinal manipulation should not be performed on infants. Neck and low back manipulation should not be performed on children.
2) Spinal manipulation may be appropriate to treat musculoskeletal conditions in adolescents.
3) Spinal manipulation is not appropriate and should not be performed to treat non-musculoskeletal paediatric conditions among infants, children, and adolescents.