Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor
Copyright 1999 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.1999
To the Editor: Several concerns are apparent
after review of the study of spinal manipulation in the treatment of ETTH
by Bove and Nilsson.1
First, in our viewpoint, the "toggle recoil technique" is not an appropriate
manipulative intervention in spinal manipulation of the upper elements of
the cervical spine. Rotary manipulation based on asymmetry of the atlas and
palpable tenderness of the facet joints would be preferable in the treatment
phase of this study. Toggle recoil technique certainly is not a technique
advanced in our curriculum and may provoke pain if excessive force is applied.
A more judicious application of rotary manipulation of the atlas and axis
may have produced a greater therapeutic effect if it was used exclusively
in the study. Furthermore, the low statistical power of this study raises
the possibility of a type II error. The authors assume that a larger study2 demonstrated positive effects of spinal manipulation
due to "personal contact" of the subject and physician. This is opinion and
conjecture on the part of the authors, and such speculation does not invalidate
the results of the larger study. The overall trend in the effects of spinal
manipulation generally is positive in larger, controlled studies.
Kaufman RL, Delaney P. Spinal Manipulation for Tension-type Headache. JAMA. 1999;282(3):231-233. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-3-jac90006