Spinal manipulation versus mobilization

The commentary by Edzard Ernst1 alerts health professionals to the possible complications of cervical manipulation. However, we feel that the commentary would have been even more clinically relevant if it had emphasized to physicians the distinction between spinal manipulation techniques and mobilization techniques. Manipulation is defined as a small- amplitude, high-velocity thrust technique — a rapid movement over which the patient has no control. Mobilizations are low-velocity techniques that can be performed in various parts of the available range based on the desired effect. Mobilization techniques have been shown to produce concurrent effects on pain, sympathetic nervous system activity, and motor activity.2^,3^,4 Mobilizations can be prevented by the patient5 and are generally considered far safer than manipulations. The majority of physiotherapists in Canada use mobilization techniques on the spine, as opposed to manipulation, while many have trained in both and are able to select the most appropriate technique for the patient's problem. It would be a shame if physicians eschewed this technique by misrepresenting Ernst's excellent commentary.

Meena Sran Osteoporosis Program Children's and Women's Health Centre of British Columbia University of British Columbia Vancouver, BC Karim Khan Department of Family Practice University of British Columbia Vancouver, BC