Thoracic manipulative practice: risks and benefits

 In recent years attention has be drawn to the risks, including adverse events of performing orthopaedic manipulative techniques to the spine in physiotherapy practice. As a result the International Federation of Orthopaedic Manipulative Physical Therapist has developed an evidence based framework and consensus document to assist clinicians in reasoning through the relative risk for use in practice. Whilst this is focused to the cervical spine, the reported risk of thoracic manipulative techniques remains a relatively unexplored area. Recent research has reported a range of adverse events following thoracic thrust techniques, including mechanical/vascular injury to the spine, pneumothorax, hamothorax and CSF leakage, albeit in a small numbers. Researchers suggest that that clinicians may not adequately screen for contraindications and precautions prior to undertaking thoracic thrust techniques despite a reported higher incidence of side effects for patients receiving thoracic thrust techniques compared to the cervical spine. With a body of evidence now advocating the use of thoracic thrust techniques over the higher risk cervical manipulative techniques for presentations such as neck pain it is important to consider the safety of such techniques.