Cervical Manipulation Flashcards
(42 cards)
To keep it safe
Small amplitude
Mid range
Localization
Low force
Force Contact point Localized Direction Amplitude Speed
Indications for manipulation - Mechanical
Hypomobility/Motion restriction Joint fixation/acute joint locking Somatic dysfunction Restore bony alignment Meniscoid entrapment/displaced disc fragment/adhesions
Indications for manipulation - Physiological
Pain modulation Reflex relaxation of muscles Reprogramming of the CNS Muscle facilitation Release of endorphins
Strength changes with cervical manipulation - study showed
Scapulothoracic muscle strength changes following a single session of manual therapy and an exercise program in patients with neck pain
Clinical practice guidelines - evidence supports that it helps in those with
Neck pain with mobility deficit (cervicalgia, pain in thoracic spine)
Neck pain with headache (HA, cervicocranial syndrome)
Absolute contraindications - highlighted ones
Bone pathology - ligamentous laxity (alar, transverse, tectorial membrane)
Neurological - cervical myelopathy (cord compression - BB changes, B symptoms, ataxic gait)
Vascular - vertebral artery insufficiency (5Ds And 3Ns), carotid artery dysfunction
Relative contraindications
Adverse reaction to previous MT Disc herniation Spondylolysis, listhesis, advanced DJD Anticoagulants or corticosteroids Psych dependence Lig laxity Pregnancy Arterial calcification Worsening condition
Adverse effects of thrust and non thrust manipulation
Neck pain/soreness Radiating pain Fatigue HA Dizziness Blurred vision Ringing in the ears
Adverse effects of thrust and non thrust manipulation - highlighted ones
Neck pain/soreness (27.7% T, 22.3% NT)
HA (15.6% T, 15.8% NT)
They are both about the same with these side effects
Safety/Prevention - study - Are adverse events preventable and are manipulations being performed appropriately?
If all contraindications and red flags were ruled out:
- 8% of adverse events could be avoided (they had an abs contra)
- 4% inappropriate (it wasn’t indicated)
- 4% unpreventable suggesting some inherent risk
One of the risk factors has to do with anatomy - explain
Vertebral and Carotid arteries
One of the risk factors has to do with anatomy - explain Vertebral artery
11% of cerebral blood flow
Supplies post cranial circulation
Greater stress with upper cervical rotation
(we are never in end range rotation)
One of the risk factors has to do with anatomy - explain Carotid artery
89% cerebral blood flow
Supplies ant cranial circulation
Greater stress with mid cervical extension
(we aren’t putting our patients into ext)
Vertebral artery dissection
Tunica intima can be peeled away from tunica media
Tunica intima itself might occlude blood flow
Thrombus
Thrombus might be formed at site awaiting to release - and then gets released by some cervical motion into the circle of willis
Is it the manipulation that injures the arteries?
Pt example of having the severe arthritis and then osteophyte that hit the artery
Mechanism of VBI - stats
Arterial dissection/spasm Brain stem lesions 43% spontaneous 31% cervical manipulation 16% trivial trauma 10% major trauma
Mechanism of VBI - info
Manipulation might have been administered to pt with a spontaneous dissection in progress
Initial symptoms of acute neck pain and HA for which they seek treatment
Almost 70% of VBI is caused by something other than the manipulation
The risk of serious complications
6/10 million
risk of death 3/10 million
Risk factors - major risk factors for stroke or artery problems
Hypertension Hypercholesterolemia Hyperlipidemia Diabetes Family hx of MI, angina, TIA, CVA, PVD Smoker BMI over 30 Repeated/recent injury Upper cervical instability
Risk factors - minor risk factors for stroke or artery problems
Vit B12/folate deficiency Estrogen based contraceptive Infections Poor diet RA Blood clotting disorders Fibromuscular dysplasia Hypermobility (marfans, EDS) Erectile dysfunction BMI 25-29
Screening for VBI in pts with neck pain - MT decision making in presence of uncertainty - Spinal fractures
Major trauma - MVA, fall from height, direct blow to C spine w/o imaging
Severe limitations during neck AROM in all directions
Screening for VBI in pts with neck pain - MT decision making in presence of uncertainty - Cervical myelopathy
Sensory disturbance of hands MM wasting of intrinsics Unsteady gait Hoffman's reflex Hyperreflexia B/B changes Multisegmental weakness and/or sensory changes
Screening for VBI in pts with neck pain - MT decision making in presence of uncertainty - Neoplastic conditions
Age over 50 Prior history of CA Unexplained weight loss Constant pain - not relieved with bed rest Night pain
