Physiotherapy, a responsible profession to use cervical manipulation. Response to Refshauge et al

Results from recent randomised controlled trials conducted by physiotherapists are contributing to the increasing evidence of the benefits of cervical manipulative therapy for the management of cervical musculoskeletal disorders (Boline 1995, Bronfort et al 2001, Hoving et al 2002, Jull et al 2002). It is known that there is a risk, albeit very slight, of devastating side effects of cervical manipulation. Issues of safety of use of high velocity cervical manipulation and risk/benefits of this procedure are of concern to all practitioners of manipulative therapy. Refshauge and colleagues (2002) have presented their views of the issues around cervical manipulation to stimulate debate amongst those professions which use cervical manipulation. The debate is welcome within the physiotherapy profession. Refshauge et al raise and present argument around four questions. It is our contention in this response that many of the arguments presented by Refshauge et al do not support their recommendations