Quantifying strain in the vertebral artery with simultaneous motion analysis of the head and neck: A preliminary investigation

The potential dangers of neck manipulation & risk for dissection and devastating stroke: An illustrative case & review of the literature

“…In a cadaveric study, Piper and colleagues show that strain and peak angular displacement during spinal manipulation is highly variable between individuals. The peak strain often occurs at an intermediate point during the movement of the neck [ 41 ]. Therefore, even in experienced hands, a high velocity spinal manipulation may not be safe based on individual anatomical differences in patients…”

Best Practices for Chiropractic Care for Older Adults: A Systematic Review and Consensus Update

“…37 • A 2014 study suggested that vertebral artery (VA) strains during global head and neck movements, including spinal manipulation, were considerably smaller than published VA failure strains. 38 • A 2014 biomechanical study found no significant changes in blood flow in the vertebral arteries of healthy young adult males after cervical spine manipulations. 39 • A 2014 statement from the American Heart Association suggested that patients should be informed of the risk of cervical arterial dissection prior to undergoing manipulation of the cervical spine.…”

“…Sixty-four articles were excluded (abstracts, not applicable to older adults, not chiropractic, no treatment outcomes, adverse events not reported), leaving 14 articles. Six of these were studies specifying older adults, 23,[29][30][31][32][33] and 8 addressed adverse events in adults in general but were considered applicable to older adults as well and were retained [34][35][36][37][38][39][40][41] (Fig 3).…”

“…The articles on adverse events related to spinal manipulation in general (not specifically in older adults) found that serious adverse events are very rare 34,35 and challenge a causal relationship with spinal manipulation. [34][35][36][37][38][39]41 The main findings from these 8 articles, which did not focus specifically on older adults, were as follows:…”

Changes in Vertebral Artery Hemodynamics Associated With McKenzie Therapeutic Cervical Movements: An Exploration Using Duplex Ultrasound Imaging

“…It has been suggested that 29,30 neck rotation can compress to the VA through the dynamic stretching to the facet that can stretch the VA, where axial rotation of the cervical spine places the VA under high strain force. 31 In contrast, another study found minimal effects from head and neck positions on the VA blood flow. 32 The McKenzie cervical approach has been shown to be an effective management strategy for cervical spine impairments for reducing pain, disability, and frequency of seeking medical care.…”