MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

If you go on Twitter you will find that chiropractors are keen like mustard to promote the idea that, after a car accident, you should consult a chiropractor. Here is just one Tweet that might stand for hundreds, perhaps even thousands:

Recovering from a car accident? If you have accident-related injuries such as whiplash, chiropractic care may provide relief. Treatments like spinal manipulation and soft tissue therapy can aid in your recovery.

In case you don’t like Twitter, you could also go on the Internet where you find hundreds of websites that promote the same idea. Here are just two examples:

A frequent injury arising from an automobile accident … is whiplash. After an accident, a chiropractor can help treat resulting issues and pain from the whiplash… Proceeding reduction in swelling and pain, treatment will then focus on manipulation of the spine and other areas.

The primary whiplash treatment for joint dysfunction, spinal manipulation involves the chiropractor gently moving the involved joint into the direction in which it is restricted.

There is no question, chiropractors earn much of their living by treating patients suffering from whiplash (neck injury caused by sudden back and forth movement of the neck often causing neck pain and stiffness, shoulder pain, and headache) after a car accident with spinal manipulation.

Why?

There are two not mutually exclusive possibilities:

  1. They think it is effective.
  2. It brings in good money.

I have no doubt about the latter notion, yet I think we should question the first. Is there really good evidence that chiropractic manipulations are effective for whiplash?

When I was head of the PMR department at the University of Vienna, treating whiplash was my team’s daily bread. At the time, our strategy was to treat each patient according to the whiplash stage and to his/her individual signs and symptoms. Manipulations were generally considered to be contra-indicated. But that was about 30 years ago. Perhaps the evidence has now changed. Perhaps manipulation therapy has been shown to be effective for certain types of whiplash injuries?

To find out, I did a few Medline searches. These did, however, not locate compelling evidence for spinal manipulation as a treatment of any stage of whiplash injuries. Here is an example of the evidence I found:

In 2008, the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) found limited evidence on the effectiveness of manual therapies, passive physical modalities, or acupuncture for the management of whiplash-associated disorders (WAD) or neck pain and associated disorders (NAD). This review aimed to update the findings of the Neck Pain Task Force, which examined the effectiveness of manual therapies, passive physical modalities, and acupuncture for the management of WAD or NAD. Its findings show the following: Evidence from 15 evaluation studies suggests that for recent neck pain and associated disorders grades I-II, cervical and thoracic manipulation provides no additional benefit to high-dose supervised exercises.

But this is most puzzling!

Why do chiropractors promote their manipulations for whiplash, if there is no compelling evidence that it does more good than harm? Again, there are two possibilities:

  1. They erroneously believe it to be effective.
  2. They don’t care but are in it purely for the money.

Whatever it is – and obviously not all chiropractors would have the same reason – I must point out that, in both cases, they behave unethically. Not being informed about the evidence related to the interventions used clearly violates healthcare ethics, and so does financially not informing and exploiting patients.

 

41 Responses to Chiropractic manipulations after car accidents: best avoided, if you ask me

  • luckily thousands of patients don’t (ask you)
    we treat RTA patients in the ER at my hospital all the time with good results but please don’t let me stop you in your crusade

  • Let us not forget to list Dr Katz, Chiropractor on your website list. He is an authority on the non-surgical management of whiplash disorders caused by motor vehicle accidents. https://katzchiropractic.com/overview/. In addition, this “quack” according to your opinion is a published author in a Harvard University peer-reviewed journal, Brain Circulation.https://pubmed.ncbi.nlm.nih.gov/31001596/ I find your quest to degrade the chiropractic profession’s contribution to human health and welfare disappointing and in my opinion, a fruitless endeavour.

    • thank you for offering the usual fallacies;
      asking chiros for EVIDENCE seems to be a fruitless endeavor!

    • Mr Epstein wrote “Let us not forget to list Dr Katz, Chiropractor on your website list. …”

      SETTINGS AND DESIGN: This study is a retrospective consecutive case series of patients in a private practice.🤣

      CONCLUSION: These results indicate that correction of cervical lordosis may be associated with an immediate increase in cerebral blood flow. Further studies are needed to confirm these findings and understand clinical implications.

      Increase in cerebral blood flow indicated by increased cerebral arterial area and pixel intensity on brain magnetic resonance angiogram following correction of cervical lordosis.
      Katz Evan A, Katz Seana B, Fedorchuk Curtis A, Lightstone Douglas F, Banach Chris J, Podoll Jessica D.
      Brain Circ. 2019 Jan-Mar;5(1):19-26

    • I just discovered this highly entertaining video of “Dr” Epstein working with a patient

      https://www.youtube.com/watch?v=ZgYHUWIWeBo

      If only he restricted himself to working with the undead people in Australia would be a lot safer

  • I see that there is another case ofvertebral artery dissection following chiropractic manipulation featured in The Independent yesterday https://www.msn.com/en-gb/health/medical/my-daughter-went-for-a-routine-chiropractor-appointment-now-she-s-paralysed/ar-AA12iFKg?ocid=msedgntp&cvid=2140faaa430041eca5fd4df2ec012e71

  • Interesting:

    “Passive joint mobilisation / manipulation may be given in combination with active exercises, in situations where exercise and advice alone are not proving effective, provided there is evidence of continuing measurable improvement. This technique should be restricted to registered health professionals trained in the specific methods of passive joint mobilisation and manipulation and undertaken according to current professional standards.”

    Clinical guidelines for best practice management
    of acute and chronic whiplash-associated disorders

    Commissioned by the South Australian
    Centre for Trauma and Injury Recovery (TRACsa)

    “Our findings suggest that passive treatments are frequently applied for WAD, which is of significant concern, and supported by a recent cross-sectional survey in which 80% of Australian GPs identified manipulation as a recommended treatment [54].”

    Evidence-based care in high- and low-risk groups following whiplash injury: a multi-centre inception cohort study. BMC Health Serv Res 19, 806 (2019).

    “Although the active implementation program increased guideline-consistent practice, patient outcomes and cost of care were not affected.”

    Evaluating two implementation strategies for whiplash guidelines in physiotherapy: A cluster-randomised trial Australian Journal of Physiotherapy
    Volume 52, Issue 3, 2006, Pages 165-174

    “Scientific evidence for the diagnosis and physiotherapeutic management of whiplash is sparse; therefore, consensus is used in different parts of the guideline.” Clinical Practice Guideline for the Physiotherapy of Patients With Whiplash-Associated Disorders March 2002Spine 27(4):412-22

    “ It would seem logical that a primary aim of early whiplash management would be to decrease levels of pain. Consistent with this are current recommendations for pain management that advocate adequate pain relief following acute injury.27, 28 Despite this, very few trials of pain relief using medication in the early stages of whiplash have been conducted.”

    Primary care management of acute whiplash injury. Chapter 11. Michele Sterling, Justin Kenardy

    • 1) “may be given” does not mean ” is effective”
      2) clinical guidelines are not always trustworthy or based on best evidence
      3) surveys do not generate good evidence of efficacy
      4) BMC Health Serv Res 19, 806 (2019) = an observational study that allows no conclusions about efficacy
      5) Australian Journal of Physiotherapy Volume 52, Issue 3, 2006, Pages 165-174 “Although the active implementation program increased guideline-consistent practice, patient outcomes and cost of care were not affected.” This was not a trial testing SMT
      6) Spine 27(4):412-22 “Scientific evidence for the diagnosis and physiotherapeutic management of whiplash is sparse; therefore, consensus is used in different parts of the guideline. The guideline reflects the current state of knowledge of the effective and appropriate physiotherapy in whiplash patients. More and better research is necessary to validate this guideline in the future.”
      THANK YOU FOR SUCH A GREAT EFFORT DEMONSTRATING THAT THERE IS NO GOOD EVIDENCE!

      7)

  • The UK Advertising Standards Authority do not permit chiropractors to advertise their treatments for whiplash because “The ASA and CAP have not seen evidence sufficient to support claims that chiropractic is effective for the treatment of whiplash, or for neck pain arising from other types of injury”. https://www.asa.org.uk/static/uploaded/330d2d20-28e3-4cf2-b4772c19555c2afa.pdf

    • I think they think chiropractic and spinal manipulation are synonyms, they are not.

      “It emphasises manual therapy including spinal manipulation and other joint and soft-tissue manipulation, joint mobilisation, and includes exercises, and health and lifestyle counselling.”

      Also,

      “The 2017 evidence review found some evidence for the use of manual therapy for whiplash, but it was not sufficiently conclusive to support the claim that chiropractic is effective for whiplash.”

      I wonder, what approach does have “sufficiently conclusive” evidence?

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