C-spine manual therapy Flashcards
“manipulation”
“quick stretching maneuver”
muscles relax, joints unlock
what are the risks?
606 cervical artery dissection cases reported in 20 studies meeting selection criteria
- 54% internal carotid artery dissection
- 46% vertebral A dissection
- 61% classified as spontaneous
- 30% associated w/ trauma/trivial trauma
- 9% associated w/ cervical spine manic
- temporal relationship of an event w/ the onset of symptoms does not necessarily imply causation
*stroke following c-spine
are there safer and equally effective alternative interventions?
- some (and growing) evidence for efficacy of neck manipulations
- much less evidence for many other routinely performed interventions
- cervical spine mobilization is not risk free
- traction, PROM, strengthening exercise are not risk free
vertebral artery
anterior (internal carotid) and posterior (VA) systems
- C2 and higher most vulnerable for problems
- contralateral rotation w/ extension thought to be most stressful
stretch/pinch separates inner and outer lining
- internal bleed
- thrombus –> embolus
- possible delay between stimulus and embolus
VBI tests do NOT test the internal carotid (small % of strokes)
incidence of manipulation induced stroke
true numbers difficult to obtain:
-under reported in the literature
-delay between manip and stroke clouds correlation and causation
(was neck pain from dissection in progress and that is what led pt. to have manic??
vertebral basilar (artery) insufficiency tests
- no not do the test if VBI is suspected
- sensitivity and specificity are poor
- all descriptions include sustained (10 second) end range rotation (some include distraction and/or extension)
supine
10 seconds in extension
max rotation each way- 10 seconds each
VBI signs
Dizzyness Disarthria-slurred speech Disphagia-trouble swallowing Diplopia- double vision Drop attacks nausea Numbness- around mouth/1 side of body Nystagmus- involuntary eye movement Headache Hearing disturbances- tinnitus (ringing) Ataxia
***PAIN– may be the only symptom in spontaneous cervical artery dissection
pain
may be the only symptoms in spontaneous cervical artery dissection
-quality, intensity, topography of pain was heterogenous
-there is a high frequency of headache in patients w/ vertebral artery dissection even w/out sub-arachnoid hemorrhage or any neurological deficit
“this is like pain I’ve never felt before”
minimize risk
assess patients carefully & thoroughly
HISTORY:
- BP- hypertension (systolic >180, diastolic >100)
- migraine
- smoking
- trauma
- arteriosclerosis
PHYSICAL EXAM:
** if there is a strong likelihood of VBI, provocative pre-manip tests should NOT be performed, and the pt should be referred
differentiating vasculogenic head and neck pain
slide 19
chiropractic manipulations
performed by chiropractors in the context of:
- professional theory: “Law of the nerve”
- examination & assessment
OMPT manipulations
performed by PTs in the context of:
- professional theory: aligned w/ medicine
- examination and assessment
WHO is treated w/ manipulation?
OMPT= only those who fall into relevant classification and whose signs and symptoms are consistent w/ whom there has been documented evidence based efficacy
for the c-spine:
- NOT neck pain w/ movement coordination impairments including whiplash
- NOT neck pain w/ radiating pain
WHAT do we treat with manipulation?
OMPT: spinal segment(s) that lack adequate mobility and ROM
WHEN is treatment provided?
OMPT: spectrum of manual guided motion (grades 1-5); use of mst gentle grade that achieves best results. part of comprehensive treatment that also includes:
- stretching/strengthening
- soft tissue (TrP, tender points, STM)
- motor control/muscle re-ed
- pt. ed.
