Hi! I’m a physical therapist with a fair amount of outpatient experience and a pretty good aptitude for it. Lately I’ve been doing Home Health and geriatric rehabilitation.
A friend of mine recently was diagnosed with a cervical spinal stenosis. She’s 41 years old, 5′ tall, weighs 110 pounds, is a runner and skier. She responded to traction a couple of years ago when she had physical therapy (not from me) to treat herniated discs at a couple of levels. Now she’s been advised by her doctor not to run nor ski.
This woman is planning to get chiropractic treatment for her neck. She has an absent triceps reflex on one side and perceptible motor weakness in that muscle. I have warned her that chiropractic is probably risky. When she had a diagnosis of only a bulging disc a few years back, I recommended the McKenzie exercise program to her. Now I would not recommend it, obviously. Her chiropractor told her that McKenzie was inappropriate, which it is at this stage, and now she thinks my advice is flawed.
What is the current thinking on manipulation for cervical spinal stenosis? I’ve been wrong before. Thanks a lot!
Neck manipulation would certainly be contraindicated when there is spinal stenosis (narrowing of the spinal canal) with a history of herniated discs and a “bulging disc” that might herniate into the spinal canal and compress the spinal cord. The weakness and loss of a reflex in her is a big red flag that leaves no doubt that neck manipulation should not be done in this case.
While neck manipulation might be beneficial in a few carefully selected cases involving some types of joint problems, it is often contraindicated when there is pathology. Because of risk of injuring neck and vertebrobasilar arteries, risk always outweighs benefit when cervical manipulation is used routinely or as a preventive measure.
Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient’s Guide provides an incisive look at chiropractic’s history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.
This page was revised on February 11, 2002.