Spinal manipulation and adverse event reporting in the pregnant patient limits estimation of relative risk: a narrative review

ABSTRACT

Objective

To describe variability in spinal manipulation technique details and adverse event (AE) documentation of spinal manipulation during pregnancy.

Methods

Five databases were searched for peer-reviewed investigations of spinal manipulation during pregnancy. Criteria for inclusion was as follows: high velocity, low amplitude thrust manipulation performed, subjects pregnant during manipulation, and English language. Studies were excluded when participants were not currently pregnant, and when the manipulation performed was not high-velocity, low-amplitude thrust. Data extraction included study design, number of participants, gestational age, spinal region, number of manipulations, manipulation technique details, profession of manipulator, AE reporting (Yes vs. No), type, and number of AE.

Results

Out of 18 studies included in the review, only three provide details of the spinal manipulation technique. The reported variables include patient position, practitioner position, and direction of thrust. Fourteen studies documented AE; however, only seven provide AE details.

Discussion

Reporting of spinal manipulation techniques and AE during pregnancy were inconsistent. Replication of methods in future investigations is limited without more detailed documentation of manipulation techniques performed. Furthermore, determining the relative risk and safety of spinal manipulation during pregnancy is not possible without more detailed reporting of AE. Due to these inconsistencies, a checklist is proposed for standardized reporting of spinal manipulation techniques and AE. With more consistent reporting of these parameters, results of future investigations may allow for more definitive and generalizable safety recommendations on spinal manipulation during pregnancy.

KEYWORDS:

• Adverse events
• female
• pregnancy
• safety
• spinal manipulation

Acknowledgment

This narrative review was in partial fulfillment of the North American Institute of Orthopaedic Manual Therapy fellowship program.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

There was no funding for this narrative review.

Notes on contributors

Kellie Stickler

Kellie Stickler, PT is a practicing physical therapist in a multidisciplinary employee health clinic. She obtained her DPT from the University of Kansas Medical Center in 2016 and became a Board Certified Orthopedic Specialist in 2019. She is a current Fellow-in-Training with the North American Institute of Orthopaedic Manual Therapy.

Gary Kearns

Gary Kearns is an Assistant Professor in the Doctor of Physical Therapy Program at Texas Tech University Health Sciences Center. He is a Board Certified Specialist in Orthopaedic Physical Therapy (OCS) and a Fellow in the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT). He is an assistant professor in the entry-level DPT program at Texas Tech University Health Sciences Center where he coordinates the musculoskeletal and differential diagnosis curriculum. His research interests include dry needling safety, clinical reasoning and mechanisms of manual therapy.