THERE is no evidence that spinal manipulation, a technique practised by 16,000 chiropractors in Britain, works, according to a study published yesterday.

A review of the evidence by Professor Edzard Ernst and Peter Canter, experts on alternative medicine, finds no convincing data to support claims that the technique is effective. With the possible exception of the relief of back pain — where spinal manipulation is as good but no better than conventional treatments — the technique is worthless, the review in the Journal of the Royal Society of Medicine concludes.

Professor Ernst, who is based at the Peninsula Medical School, Exeter, said: “The findings are of concern because chiropractors and osteopaths are regulated by statute in the UK. Patients and the public at large perceive regulation as proof of the usefulness of treatment. Yet the findings presented here show a gap and contradiction between the effectiveness of intervention and the evidence.”

The British Chiropractic Association reacted angrily to the findings. In a statement, it said that it was disappointed that the RSM would publish such a “biased” article. “Ernst and Canter have carefully selected negative articles in support of their conclusion that manipulation cannot be recommended as a treatment when national clinical practice guidelines, based on much more and better research than the studies this article has selected, have come to exactly the opposite conclusion,” the statement said. “The usefulness of manipulation is that it can be added, substituted or modified as part of a package of care that provides management, pain control, advice and recognises risks to a good recovery.”

Professor Ernst’s paper does not include any new research. Rather, it examines all the reviews of research carried out on spinal manipulation by other people and published between 2000 and May 2005.

Sixteen papers were included, covering a range of conditions claimed by chiropractors to be helped by spinal manipulation: back pain, neck pain, painful periods, colic in babies, asthma, allergy and cervicogenic dizziness (a form of dizziness caused by neck problems).

Spinal manipulation to treat these conditions is carried out largely, but not exclusively, by chiropractors. Physiotherapists and osteopaths may also use the technique.

The aim is to adjust the small joints between the bones in the spine to relieve pain and stiffness. But the medical literature does not provide any real evidence that it works, Professor Ernst and Dr Canter have concluded.

“Considering the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment,” they said.

As they imply, spinal manipulation is not entirely risk-free. In 2001, a team from Professor Ernst’s unit published the results of a survey of 323 neurologists working at British hospitals. Of the 239 who responded to a questionnaire, 24 said that they could recall cases of severe nerve damage occurring in patients within 24 hours of spinal manipulation.

“Spinal manipulation has been associated with frequent, mild adverse effects and with serious, probably rare implications,” Professor Ernst said in the latest paper. “One way forward is more rigorous clinical trials to test the efficacy of spinal manipulation.”

• Angina, which affects about two million people in Britain, is more common in women than previously thought, according to research. The University College London researchers found that two women out of every 100 develop angina as the first sign of heart disease, a similar proportion to men.

  HANDS-ON

  Chiropractic Founded in the late 19th century by D. D. Palmer, the technique gets its name from the Greek words for hand and, loosely, action. Its essence is manipulation with hands

  Osteopathy Claims to treat a multitude of pains, strains and aches of the muscles and joints. Osteopaths diagnose by touch and treat by massage and by advice on exercise, posture or diet. Works on the basis that the impairment of blood supply, not nerves, is the root of problems

  Physiotherapy Also uses massage and manipulation to treat pain, stiffness and injury

  Massage Deals only with soft tissues

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