ICSC Spotlight: An Osteopathic Physician Discusses His Approach to Cervical Spine Manipulation

The Interprofessional Collaborative Spine Conference (ICSC), set for Nov. 8-9 in Pittsburgh, Pa., will bring together members of the chiropractic, osteopathic medicine and physical therapy professions to tackle topics related to manual therapy and its use in treating low back pain and other conditions. As part of the presentation “Osteopathic Manipulative Treatment (OMT) Competency, Safety and Risk Management Presentations,” Michael Seffinger, DO, a professor at the College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, discusses the osteopathic approach to ensuring the appropriateness and safety of cervical spine manipulation for patients.

Why is your topic important for today’s healthcare provider?

There is a responsibility of healthcare professionals, and an expectation from their patients, to deliver safe and effective health care. To this end, we have regulatory bodies in each state that oversee the standards of practice performed by the various professionals that deliver health care. In addition, in the 1990s, a national movement to improve the quality of American health care was started by the Institute of Medicine (IOM). One result of that movement was the creation of the National Quality Forum, which is a non-profit organization that enables various healthcare professionals to gather to discuss how to improve the quality and safety of health care in America through strategies such as measurement and public reporting.

One issue raised in these discussions was the safety of procedures, including spinal manipulation. This topic has been widely debated among neurologists and surgeons as well as MDs and PhDs, some of whom feel strongly that spinal manipulation, especially of the cervical spine, is not indicated nor safe. However, the professions that perform spinal manipulation feel strongly otherwise, as do their patients who benefit from this treatment modality.

The challenge for us is not only to demonstrate the appropriateness of spinal manipulation but also the safety of this procedure and the quality of education and training provided to the next generation within our educational programs. We need to determine the factors that enable a clinician to provide safe manipulation of the cervical spine. It begins with an accurate diagnosis. Students in health professions who use this procedure must be competent in their understanding of anatomy, pathophysiology and the nature of all disease conditions in the cervical region and understand the biomechanics of not only the bones and joints but the soft tissues, as well.

What about your presentation topic may surprise people?

Educational specialists recommend a 1:1 ratio of instructor to student as the best way to teach a delicate procedure that has risks associated with it.  Minimum ratios in a classroom recommend no more than four students to one instructor – but the instructor must teach 1:1 for certain procedures, including spinal manipulative therapies.  There is a recognized association of cervical artery injury with a forceful movement of the cervical spine whether done actively by the patient or passively as performed by the clinician with a relaxed patient. Students, validated by a licensed professional instructor, must demonstrate competency in making a proper diagnosis and then further demonstrate their ability to do the procedure properly, accurately and safely. The instructor must also oversee the clinical experience to observe the decision-making process of each student, to ensure they understand the appropriateness in each clinical situation of applying this procedure.

Are there any new developments in your topic area that make your presentation at ICSC especially relevant or timely?

In the 1990s the RAND Corporation put together a multidisciplinary panel of experts to review research on cervical manipulation and came up with some recommendations about when they felt it was appropriate to use in various clinical scenarios. In 2015, another panel was created to address this issue again and review the literature from the previous 20 years to determine whether the appropriateness of the procedure had changed over the years.  As part of the process of developing these recommendations, the panel discussed the risk versus the benefit of cervical spine manipulation.  With this information, I created a template to help clinicians determine the relative risk versus benefit—and thus the safety—of cervical manipulation in any clinical scenario. I have shared it with various experts in the field and will discuss it during my presentation.

What practical knowledge or skills can attendees expect to take away from your presentation?

Attendees will be able to:

  • cite the methods used by the osteopathic profession to ensure safety and competency in their physicians who perform osteopathic manipulative treatment of the cervical spine.
  • state the differential diagnosis of neck pain in ambulatory patients and how that relates to professional standards of care of patients presenting with neck pain.
  • determine the relative risk on a scale of 0-10 of performing cervical manipulation on a patient in any given clinical scenario.
  • cite the evidence for and against using cervical manipulation as presented in scientific/professional journals.


ICSC will bring together researchers and practitioners of the chiropractic, physical therapy and osteopathic professions to initiative a dialogue on the use of manual therapies and non-pharmacological approaches for the management of pain. The event, which takes place Nov. 8-9 in Pittsburgh, Pa., aims to help participants identify opportunities for interprofessional research and collaboration, raise awareness among the professions, and develop interprofessional care pathways. To learn more, including hotel and registration information, click here.