Pre-manipulative Procedures for the Cervical Spine: New guidelines and a time for dialectics: Knowledge, risks, evidence and consent

Abstract

Summary The Australian Physiotherapy Association has recently released updated guidelines for pre-manipulative procedures for the cervical spine ( Magarey, 2000 Magarey M, Coughlan B, Rebbeck T (2000). Australian Physiotherapy Association Clinical Guidelines for Pre-manipulative Testing of the Cervical Spine, available from the Australian Physiotherapy Association, PO Box 6465, St Kilda Road Central, Melbourne, Victoria 8008, Australia. Google Scholar ). These guidelines replace the protocol published in 1988 (APA, 1988), upon which much manipulative practice in Britain has been based. Therefore the recognition of the new protocol is of paramount importance in our manipulative community. Following the release of these guidelines, the Australian Journal of Physiotherapy published a discussion forum inviting comment from learned and interested individuals in the field of manipulative therapy ( Australian Journal of Physiotherapy, 2001 Australian Journal of Physiotherapy ‘Forum: Pre-manipulative testing of the cervical spine’. Australian Journal of Physiotherapy. 2001; 47: 163-167 PubMed Google Scholar ). This discussion forum is perhaps of greater importance than the release of the guidelines itself. The forum highlights some of those great areas of debate in our profession that seemingly move further away from a communal consensus of opinion. These are the issues of established public knowledge base, risk of practice, evidence-based practice, and informed consent. The area of cervical manipulation is perhaps the most sensitive and logical area to discuss these issues, and the journal's forum certainly proved that consensus of opinion on any of these areas is a goal yet to be within sight. This article discusses each of these issues in turn with reference to points raised by the forum on pre-manipulative testing of the cervical spine. The Australian Physiotherapy Association has recently released updated guidelines for pre-manipulative procedures for the cervical spine ( Magarey, 2000 Magarey M, Coughlan B, Rebbeck T (2000). Australian Physiotherapy Association Clinical Guidelines for Pre-manipulative Testing of the Cervical Spine, available from the Australian Physiotherapy Association, PO Box 6465, St Kilda Road Central, Melbourne, Victoria 8008, Australia. Google Scholar ). These guidelines replace the protocol published in 1988 (APA, 1988), upon which much manipulative practice in Britain has been based. Therefore the recognition of the new protocol is of paramount importance in our manipulative community. Following the release of these guidelines, the Australian Journal of Physiotherapy published a discussion forum inviting comment from learned and interested individuals in the field of manipulative therapy ( Australian Journal of Physiotherapy, 2001 Australian Journal of Physiotherapy ‘Forum: Pre-manipulative testing of the cervical spine’. Australian Journal of Physiotherapy. 2001; 47: 163-167 PubMed Google Scholar ). This discussion forum is perhaps of greater importance than the release of the guidelines itself. The forum highlights some of those great areas of debate in our profession that seemingly move further away from a communal consensus of opinion. These are the issues of established public knowledge base, risk of practice, evidence-based practice, and informed consent. The area of cervical manipulation is perhaps the most sensitive and logical area to discuss these issues, and the journal's forum certainly proved that consensus of opinion on any of these areas is a goal yet to be within sight. This article discusses each of these issues in turn with reference to points raised by the forum on pre-manipulative testing of the cervical spine.