Monday 11 June 2012

BMJ, Manipulating the manipulators!

BMJ Manipulating the manipulators!

What fun the BMJ are having. Take three authors will little or no track record in the field, get them to review a few 'Cherry picked' papers, write a non-peer reviewed opinion/debate article ( add a press release ( and light the touch paper! 

Enter the 'Daily Mail' (, fan the flames and watch the manipulators eat themselves. Nice . . . Or is it? 

We learnt a lot in Physiotherapy about the haemodynamics of the cervical spine and risk assessment over the last decade or so. We had seen the limitations of our own 'bad science', the vertebral artery test and IFOMPT will this year provide guidance to those who treat the cervical spine in a well thought out attempt to limit risk.

Wand et al (2012) have been manipulated themselves, and whilst they clearly enjoy the spotlight (#abandonneckmanipulation on Twitter "woohoo") their argument is weak and badly thought out (see the considered respondents on the BMJ site) and furthermore is harmful to the profession. My last two (expert witness) medico-legal cases involving stroke post manual therapy, were in fact not manipulation cases, but rather ASSESSMENT CASES . . . Oh, I hear the wolves call, perhaps we should call a halt to assessment and movement too? Then we truly can stick to handing out leaflets (

So unwittingly we (as a profession) fall into the trap set by the BMJ, we antagonise the Chiropractors/osteopaths and call our own profession into question. We have more to learn about haemodynamics and risk in the cervical spine I have no doubt . . . but
is this the way to operate in what is already a challenging and hostile environment? There really is no strong scientific case for calling a halt to manipulative therapy, any more there is many components of conventional medicine. You can read the debate yourself and I would invite you to make up your own mind.

In the mean time take the opportunity to vote on the BMJ website . . . Have your say, they did . . . in the most manipulative way.

1. Kerry R, Taylor AJ, Mitchell, JM, McCarthy C. Cervical arterial dysfunction and manual therapy: A critical literature review to inform professional practice. Manual Therapy 2008;13: 278-288
2. Bowler N, Shamley D, Davies R. The effect of a simulated manipulation position on internal carotid and vertebral artery blood flow in healthy individuals. Manual Therapy 2011; 16: 87-93
3. Kerry R, Taylor AJ. Cervical arterial dysfunction: knowledge and reasoning for manual physical therapists. Journal of Orthopaedic and Sports Physical Therapy 2009; 39:378-387
4. Vogel S, Mars T, Keeping S et al 2012 Clinical Risk Osteopathy and Management (CROaM) project: national cross-sectional survey. BSO, London.
5. Carnes D, Mars TS, Mullinger B, Froud R, Underwood M. Adverse events and manual therapy: A systematic review. Manual Therapy 2010;15: 355-363
6. Taylor AJ, Kerry R. A systems based approach to risk assessment of the cervical spine prior to manual therapy. International Journal of Osteopathic Medicine 2010;13:85-93

1 comment:

  1. Aaaah, it all becomes clearer!!

    The BMJ have made the article 'pay per view' on their web site now. So it truly was a cynical publicity stunt in the style of Rupert Murdoch . . . and we truly did fall for it!