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Joining the discussion on whether our profession is meeting its full responsibilities to provide optimum care (Refshauge et al 2002) for patients receiving cervical manipulation, I offer these personal observations.

When shoulder movements become restricted in all directions, the literature reports that contracture of the joint capsule is not present in every case. These findings suggest a different underlying pathology in some cases, which restricts shoulder movements in a manner resembling contracture. In order to investigate the concept of another mechanism, fourteen patients were selected with a specific pattern of shoulder stiffness: a gross restriction of lateral rotation associated with only moderate restrictions of abduction and medial rotation. The patients were treated with mobilization of the lower cervical spine, which resulted in an improvement in the range of lateral rotation of the shoulder, the most restricted movement. These results suggest a correlation between the cervical spine and shoulders with this pattern of movement restrictions.

Facet movements in the mid-cervical spine (C2-C4) were examined on two cervical columns from preserved cadavers. The dissected columns were clamped to allow manual movement of one vertebra on the fixed vertebra beneath. Pins were inserted to mark the position of the facets, and movement changes recorded photographically; 160 measurements were taken from these photographs. The study showed that the facets of the free vertebra could be moved to either side in relation to the facets of the fixed vertebra. Furthermore during movements simulating lateral flexion and rotation, sideways translation of the facets was found to be part of the complex three dimensional motion.