A cross-sectional postal survey of musculoskeletal physiotherapists’ opinions towards the published theory of cervical spine manipulation

Abstract Purpose Survey the opinions of physiotherapists on the published theory of cervical spine manipulation, to assist the physiotherapist in achieving informed consent in advance of planned orthopaedic manual therapy interventions. Method A self-administered postal survey was validated, and then sent to 325 physiotherapists working in musculoskeletal practices in Dorset and Hampshire, United Kingdom. Results Four articles presenting theories of cervical manipulation were found in the search of literature published during 2008–2011. Nine theories from the literature are presented within the survey: four theories are accepted by more than 50% of the sample. Conclusions When a patient asks how manipulation works, before any of the theories are offered to the patient, it can be elucidated that the theoretical base underpinning every aspect of cervical manipulation is still underdeveloped. This study finds popular theory accepted by over 70% of physiotherapists, namely that spinal manipulation activates mechanoreceptors and proprioceptors, which results in a hypoalgesic effect. Alternatively, one could rely on the approval of the highly qualified physiotherapists who had passed specialized postgraduate examinations; cervical manipulation activates descending inhibitory pain pathways through the midbrain periaqueductal grey region resulting in pain relief.