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“Provocative testing before cervical manipulation is widely recommended in the chiropractic literature. The validity of such testing is questionable, and at any rate the HVLA maneuver is not part of the provocative test and it is the likely culprit. Regardless of the magnitude of risk, the existence of a risk is undeniable and patients should know there is a risk before they agree to treatment. The Association of Chiropractic Colleges suggests informed consent but does not mandate it...any degree of risk is unacceptable when there is no benefit. A Cochrane systematic review has shown that HVLA manipulations are no more effective for neck pain than gentle mobilization and that neither is effective unless used in conjunction with an exercise program. And there is even less evidence for benefit in non-neck-related conditions. NUCCA practitioners and other chiropractors who manipulate necks for almost any complaint are clearly out of line.” Harriet Hall, MD, Science Based Medicine (14th August 2012)