Cervical Arterial Dysfunction: Knowledge and Reasoning for Manual Physical Therapists

The Pearls and Pitfalls of Magnetic Resonance Imaging for the Spine

“…On the contrary, current recommendations from the Manipulation Association of Chartered Physiotherapists in the United Kingdom suggest that consideration of atherosclerotic risk factors, in tandem with neurologic screening tests (eg, cranial nerve testing), may assist in identifying at-risk patients. We encourage reading the excellent works by Kerry et al 64 on this topic. Such consideration of hemodynamic and neurologic functioning in patients with cervical disorders may help improve clinicians' understanding of the risks and underlying mechanisms of vascular events, thus improve their ability to know when to refer the patient for further medical workup, which may include conventional and/or advanced vascular studies.…”

Immediate Changes in Widespread Pressure Pain Sensitivity, Neck Pain, and Cervical Range of Motion After Cervical or Thoracic Thrust Manipulation in Patients With Bilateral Chronic Mechanical Neck Pain: A Randomized Clinical Trial

“…nipulation are well documented, and, as a result, premanipulative screening tools have mostly focused on identifying individuals who may experience vertebrobasilar insufficiency or may have cervical arterial dysfunction. 27 Nevertheless, the use of these screening tools to rule out the risk of arterial dissection associated with cervical spine thrust manipulation is controversial. 43 Historically, the mechanisms of spinal thrust manipulation have been hypothesized to be primarily biomechanical in nature, and, recently, it has been demonstrated that the effects of spinal thrust manipulation may be neurophysiological in origin.…”

Thoracic Spine Thrust Manipulation Improves Pain, Range of Motion, and Self-Reported Function in Patients With Mechanical Neck Pain: A Systematic Review

“…24,27,37 Moreover, the literature has recommended avoiding manual therapies at terminal ranges of motion 4 and cautioned against the use of cervical thrust manipulation due to the perceived risk of serious vascular complications, especially in specific subgroups of the population. 27,32,34 Alternatively, thoracic spine thrust manipulation may effectively address mechanical neck pain. 4,32 There is a recent but growing body of literature evaluating the clinical effectiveness of thoracic spine thrust manipulation for patients with mechanical neck pain.…”