Manual Therapy and Cervical Arterial Dysfunction, Directions for the Future: A Clinical Perspective

Kerry, Roger; Taylor, A.B.; Mitchell, Jeanette; McCarthy, Christopher J.; Brew, J. O.

doi:10.1179/106698108790818620

Cited by 40 publications

(38 citation statements)

References 65 publications

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“…12,14,40,56,57 Although beyond the scope of the current article, the most recent and robust evidence for the risk of vertebrobasilar stroke and cervical HVLA thrust manipulation comes from the case control study by Cassidy et al 14 Contrary to traditionally held views, 83,87 Cassidy et al 14 found no evidence of excess risk of vertebrobasilar stroke associated with cervical HVLA thrust manipulation as compared to primary medical physician care. Moreover, a recent systematic review 12 concluded that there has been no strong evidence linking the occurrence of serious adverse events with the use of cervical manipulation or mobilization in adults with neck pain.…”

Section: Risks Of Cervical Hvla Thrust Manipulation and Nonthrust Mobmentioning

confidence: 79%

“…The most recent literature suggests that premanipulative cervical artery testing may be unable to identify individuals at risk of vascular complications from cervical HVLA thrust manipulation 57,92 and that any symptoms detected during premanipulative testing may be unrelated to changes in blood flow in the vertebral artery, so that a negative test may neither predict the absence of arterial pathology nor the propensity of the artery to be injured during cervical HVLA thrust manipulation, with testing being neither sensitive or specific. 56,57,63,65,92 Screening questions for cervical artery disease were negative, and premanipulative cervical artery testing was not used.…”

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confidence: 99%

“…56,57,63,65,92 Screening questions for cervical artery disease were negative, and premanipulative cervical artery testing was not used. This study was approved by the Institutional Review Boards of the University of South Carolina, Northeast Hospital Corporation, and the Corporate Clinical Research Committee.…”

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confidence: 99%

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Upper Cervical and Upper Thoracic Thrust Manipulation Versus Nonthrust Mobilization in Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial

Dunning¹,

Cleland²,

Waldrop³

et al. 2012

Journal of Orthopaedic & Sports Physical Therapy

136

110

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A pproximately 54% of individuals have experienced neck pain within the last 6 months, 24 and the incidence of neck pain may be increasing. 76 The economic burden associated with the management of patients with neck pain is high, second only to low back pain in annual workers' compensation costs in the United States. 98Two recent clinical prediction rules 17,21,22,81 have been developed in an attempt to guide treatment selection for patients with neck pain. However, one has yet to be validated and only identifies those patients with neck pain likely to benefit from cervical traction, 81 and the other, which attempted to identify those patients with neck pain likely to benefit from thoracic manipulation and a general cervical range-of-motion (ROM) exer- T T METHODS:Patients completed the Neck Disability Index, the numeric pain rating scale, the flexion-rotation test for measurement of C1-2 passive rotation range of motion, and the craniocervical flexion test for measurement of deep cervical flexor motor performance. Following the baseline evaluation, patients were randomized to receive either HVLA thrust manipulation or nonthrust mobilization to the upper cervical (C1-2) and upper thoracic (T1-2) spines. Patients were reexamined 48-hours after the initial examination and again completed the outcome measures. The effects of treatment on disability, pain, C1-2 passive rotation range of motion, and motor performance of the deep cervical flexors were examined with a 2-by-2 mixed-model analysis of variance (ANOVA). T T RESULTS:One hundred seven patients satisfied the eligibility criteria, agreed to participate, and were randomized into the HVLA thrust manipulation (n = 56) and nonthrust mobilization (n = 51) groups. The 2-by-2 ANOVA demonstrated that patients with mechanical neck pain who received the combination of upper cervical and upper thoracic HVLA thrust manipulation experienced significantly (P<.001) greater reductions in disability (50.5%) and pain (58.5%) than those of the nonthrust mobilization group (12.8% and 12.6%, respectively) following treatment. In addition, the HVLA thrust manipulation group had significantly (P<.001) greater improvement in both passive C1-2 rotation range of motion and motor performance of the deep cervical flexor muscles as compared to the group that received nonthrust mobilization. The number needed to treat to avoid an unsuccessful outcome was 1.8 and 2.3 at 48-hour follow-up, using the global rating of change and Neck Disability Index cut scores, respectively. T T CONCLUSION:The combination of upper cervical and upper thoracic HVLA thrust manipulation is appreciably more effective in the short term than nonthrust mobilization in patients with mechanical neck pain. T T LEVEL OF EVIDENCE:Therapy, level 1b.

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Section: Risks Of Cervical Hvla Thrust Manipulation and Nonthrust Mobmentioning

confidence: 79%

mentioning

confidence: 99%

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Upper Cervical and Upper Thoracic Thrust Manipulation Versus Nonthrust Mobilization in Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial

Dunning¹,

Cleland²,

Waldrop³

et al. 2012

Journal of Orthopaedic & Sports Physical Therapy

136

110

View full text Add to dashboard Cite

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“…Regardless of the evidence, or lack thereof, it is the responsibility of the clinician to perform screening examinations and clearly document their use to reduce legal risk if an AE were to occur with CSM. 11,108,112,113 With uncertainty regarding screening tools, clinicians must use additional strategies (e.g. red flags) for decision-making when choosing to use CSM.…”

Section: Discussionmentioning

confidence: 99%

Safety of cervical spine manipulation: are adverse events preventable and are manipulations being performed appropriately? A review of 134 case reports

Puentedura

March

Anders

et al. 2012

Journal of Manual & Manipulative Therapy

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Background: Cervical spine manipulation (CSM) is a commonly utilized intervention, but its use remains controversial.Purpose: To retrospectively analyze all available documented case reports in the literature describing patients who had experienced severe adverse events (AEs) after receiving CSM to determine if the CSM was used appropriately, and if these types of AEs could have been prevented using sound clinical reasoning on the part of the clinician. Data sources: PubMed and the Cumulative Index to Nursing and Allied Health were systematically searched for case reports between 1950 and 2010 of AEs following CSM. Study selection: Case reports were included if they were peer-reviewed; published between 1950 and 2010; case reports or case series; and had CSM as an intervention. Articles were excluded if the AE occurred without CSM (e.g. spontaneous); they were systematic or literature reviews. Data extracted from each case report included: gender; age; who performed the CSM and why; presence of contraindications; the number of manipulation interventions performed; initial symptoms experienced after the CSM; and type of resultant AE. Data synthesis: Based on the information gathered, CSMs were categorized as appropriate or inappropriate, and AEs were categorized as preventable, unpreventable, or unknown. Chi-square analysis with an alpha level of 0.05 was used to determine if there was a difference in proportion between six categories: appropriate/preventable, appropriate/unpreventable, appropriate/unknown, inappropriate/ preventable, inappropriate/unpreventable, and inappropriate/unknown. Results: One hundred thirty four cases, reported in 93 case reports, were reviewed. There was no significant difference in proportions between appropriateness and preventability, P5.46. Of the 134 cases, 60 (44.8%) were categorized as preventable, 14 (10.4%) were unpreventable and 60 (44.8%) were categorized as 'unknown'. CSM was performed appropriately in 80.6% of cases. Death resulted in 5.2% (n57) of the cases, mostly caused by arterial dissection. Limitations: There may have been discrepancies between what was reported in the cases and what actually occurred, since physicians dealing with the effects of the AE, rather than the clinician performing the CSM, published many of the cases. Conclusions: This review showed that, if all contraindications and red flags were ruled out, there was potential for a clinician to prevent 44.8% of AEs associated with CSM. Additionally, 10.4% of the events were unpreventable, suggesting some inherent risk associated with CSM even after a thorough exam and proper clinical reasoning.

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“…The increased spinal neuron activity can lead to the development of hyperalgesia and allodynia 9 in the peripheral tissues and can cause increased muscle tone or the subjective sensation of pain. 14,15 Physical therapists frequently use manipulation as an intervention in the management of patients with neck pain [16][17][18][19][20] as it has been shown to be effective. [21][22][23] Although the exact physiological mechanisms underlying spinal manipulative techniques is still unknown, a few hypotheses have been proposed offering mechanical, neurophysiological, and psychological rationales.…”

Section: Introductionmentioning

confidence: 99%

Immediate effects of a thoracic spine thrust manipulation on the autonomic nervous system: a randomized clinical trial

Sillevis¹,

Cleland²,

Hellman³

et al. 2010

Journal of Manual & Manipulative Therapy

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Thoracic spine manipulation has been shown to be effective for the management of neck pain. The purpose of this study was to investigate the immediate effect of a T3-T4 spinal thrust manipulation on autonomic nervous system activity in subjects with chronic cervical pain. An additional aim was to determine if the manipulation resulted in an immediate pain relief in patients with chronic neck pain when compared to a placebo intervention. One hundred subjects with chronic neck pain were randomly assigned to receive either a thoracic thrust manipulation or a placebo intervention. The Friedman's test was used to evaluate the change in pupil diameter within both groups. The Wilcoxen signed-ranks test was used to explore pupil changes over time and to make paired comparisons of the pupil change between the groups. The MannWhitney U test was used to compare the change in pain perception for the chronic cervical pain group subjects receiving either the thrust manipulation or the placebo intervention. The results demonstrated that manipulation did not result in a change in sympathetic activity. Additionally, there was no significant difference in the subject's pain perception (P50.961) when comparing the effects of the thrust manipulation to the placebo intervention within this group of subjects with chronic neck pain. The clinical impression of this study is that manipulation of the thoracic spine may not be effective in immediately reducing pain in patients with chronic neck pain.

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Manual Therapy and Cervical Arterial Dysfunction, Directions for the Future: A Clinical Perspective

Cited by 40 publications

References 65 publications

Upper Cervical and Upper Thoracic Thrust Manipulation Versus Nonthrust Mobilization in Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial

Upper Cervical and Upper Thoracic Thrust Manipulation Versus Nonthrust Mobilization in Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial

Safety of cervical spine manipulation: are adverse events preventable and are manipulations being performed appropriately? A review of 134 case reports

Immediate effects of a thoracic spine thrust manipulation on the autonomic nervous system: a randomized clinical trial

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