In the field of physical therapy, there is debate as to the clinical utility of premanipulative vascular assessments. Cervical artery dysfunction (CAD) risk assessment involves a multi-system approach to differentiate between spontaneous versus mechanical events. The purposes of this inductive analysis of the literature are to discuss the link between cervical spine manipulation (CSM) and CAD, to examine the literature on premanipulative vascular tests, and to suggest an optimal sequence of premanipulative testing based on the differentiation of a spontaneous versus mechanical vascular event. Knowing what premanipulative vascular tests assess and the associated clinical application facilitates an evidence-informed decision for clinical application of vascular assessment before CSM.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708008 | PMC |
| http://dx.doi.org/10.1589/jpts.32.775 | DOI Listing |
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Strain of the vertebral artery during passive neck movements and spinal manipulation of the cervical spine: An observational study.
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In the field of physical therapy, there is debate as to the clinical utility of premanipulative vascular assessments. Cervical artery dysfunction (CAD) risk assessment involves a multi-system approach to differentiate between spontaneous versus mechanical events. The purposes of this inductive analysis of the literature are to discuss the link between cervical spine manipulation (CSM) and CAD, to examine the literature on premanipulative vascular tests, and to suggest an optimal sequence of premanipulative testing based on the differentiation of a spontaneous versus mechanical vascular event.
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Article Synopsis
- There is no proven link between cervical spine manipulation and major adverse events (MAE), but manual therapists should still aim to avoid potential risks.
- Despite recent recommendations, the validity of tests for vertebrobasilar insufficiency (VBI) is low, as they often yield false negatives and aren't reliable indicators of serious neurovascular issues.
- Patient interviews can effectively identify VBI symptoms and should be prioritized over ineffective VBI tests, which may wrongly suggest that a negative result means it's safe to proceed with manipulation.
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