The appropriateness of manipulation and mobilization of the cervical spine

This report presents results from the RAND study on the appropriateness of spinal manipulation and mobilization of the cervical spine. The study was designed to ascertain the clinical criteria for the appropriate use of cervical manipulation and mobilization to treat conditions such as neck pain and headache and to document treatment complications. A review was conducted of more than 500 articles from the medical and chiropractic literature. From this extensive review, a set of indications was created for manipulation and mobilization for neck pain and headaches and for subcategories of patient types. A panel was convened of back-pain experts from the disciplines of orthopedics, chiropractic, family medicine, and neurology to rate for appropriateness the indications for spinal manipulation and mobilization. The panelists rated the set of indications individually and then were convened as a group to rate the same indications following reporting and discussion of the individual ratings. This report presents the results of the final ratings and describes the methodology. It should be of interest to clinicians who perform manipulation and mobilization of the cervical spine, to clinicians who work with patients with cervical problems, and to health researchers and others concerned with the appropriate indications for performing manipulation and mobilization.