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As no vertebral joint ever moves in isolation, and as variations in movement are common between different vertebral levels and between left and right, clinical identification of ‘normal range’ remains a dream. So, therefore, must ‘normal integrity’.1
Spinal manipulation is commonly used by osteopaths, not occasionally.
The declared therapeutic aim in chiropractic is to restore normal vertebral alignment. This is questionable, as no vertebra is bilaterally symmetrical and no two vertebrae are identical, so that clinical identification of misalignment is scientifically unsound.1 What we may feel is differences in knobbliness—due to asymmetry, misalignment, or both.
One of the reasons why chiropractors show predominance in manipulation is their frequent prescription of a course of a dozen sessions. Clinical resolution is common after a single manipulation, while non-resolution after three is an indication for a therapeutic re-think.2 This must distort the validity of Ernst's findings (JRSM 2007;100:330-338).3
Over forty years of manipulative practice, I failed to help many patients, but, after thousands of manipulations, I am aware of only two instances of causing harm, both the direct outcome of the patient failing to answer my questions honestly, thus hiding a contraindication. The contraindications to vertebral manipulation are clearly set out and are of greater importance than manual skills.4,5
To Ernst's final sentence I would but comment on the enormous number of patients who seek spinal manipulation for the very good reason that they find it commonly helps. Should the medical profession not take a more positive attitude?
Competing interests None declared