Article from The Straits Times Forum Online 26 Jan 2011
http://www.straitstimes.com/STForum/OnlineStory/STIStory_628178.html

Chiropractic increasingly going mainstream

CONTRARY to Dr Andy Ho's assertion ("Perils of chiropractic neck manipulation"; last Friday), chiropractic is a profession recognised by the World Health Organisation (WHO) and has mandatory government registration in most developed countries.

It has high standards of education endorsed by WHO guidelines as a first professional degree. It is increasingly being integrated in mainstream health-care systems throughout the world.

It is perhaps due to awareness of the high degree of cooperation by spine care providers, including chiropractors, in the international research arena and in elite university clinical settings, that practising medical doctors in Singapore have not spoken out against chiropractic.

WHO's Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders report was published in Spine in 2008. This task force was made up of internationally renowned medical specialists in the fields of orthopaedics, neurology, epidemiology, psychiatry, rheumatology, eminent chiropractors, physiotherapists and others. Among its conclusions were the following:

- Manipulation and mobilisation are safe, effective and appropriate treatment approaches for most patients with disabling neck pain.
- The risk of vertebrobasilar stroke, a very rare form of stroke that has been associated with chiropractic adjustment, is exactly the same for neck pain patients, whether they consult a doctor of chiropractic or a primary care medical physician. An estimated 80 per cent of such stroke patients have neck pain from artery dissection during the days before their strokes. This leads them to seek medical or chiropractic care and the subsequent stroke is therefore "associated with" rather than "caused by" the medical or chiropractic care.

The English-language medical literature regarding this issue goes back to 1934, and includes 26 cases of death "associated with" manipulation, with millions upon millions of manipulative procedures having been performed. It must also be realised that many forms of skilled to unskilled cervical manipulation are also being performed by manipulative physiotherapists, traditional Chinese medicine practitioners, Thai and other traditional masseurs, and old-fashioned Indian barbers. And people are not dropping like flies. By any measure of medical safety, this is a phenomenally safe therapy.

The chiropractic profession recognises that vertebral artery dissection is "associated with" cervical spine manipulation, and has done significant research into this area. Chiropractors, because of the depth of their training and their focus on manual therapy and manipulation, are therefore acutely aware of this uncommon condition and make every effort to identify patients who require immediate medical referral.

Janet Ruth Sosna (Ms)
President, Asia Pacific Chiropractic Doctors' Federation