Cervical Manual Therapy Flashcards
What percentage of cervical artery dissection cases are of the internal carotid artery?
54 %
What percentage of cervical artery dissection cases are of the vertebral artery?
46 %
What percentage of cervical artery dissections are classified as spontaneous?
61 %
What percentage of cervical artery dissections were associated with trauma/ trivial trauma?
30 %
What percentage of cervical artery dissections were associated with cervical spine manipulation?
9 %
How often does a stroke occur following cervical spine manipulation?
- Varies from study to study
1: 10,000 –> 1:5.85 Million
Is it more dangerous to drive in your car or to recieve a c-spine manipulation?
Driving in car
How likely is riding an airline to be fatal?
1:8 million
How likely is the development of a GI bleed while receiving NSAIDS?
4:1,000
Is a cervical manipulation or an NSAID more likely to be fatal?
NSAIDS 4 times more risky than the most severe c-spine manip statistics
Is there more evidence for C-spine manipulation or other therex type techniques for neck pain?
C-spine manips
Are mobilizations, traction, PROM, and strengthening risk free?
- No.
At which vertebra and above is the vertebral artery most at risk for dissection?
C2
What combination of motions is thought to be the most stressful to the vertebral artery?
- Contralateral rotation with extension
What is the mechanism of stroke following a cervical manipulation?
- Stretch/ pinch separates inner and outer lining of the artery leading to an internal bleed
- Thrombus forms –> Dislodges or flakes off to become an embolus
- Travels to small diameter arteries
- Causes ischemia/ infarct
Is stroke following dissection of the vertebral artery immediately apparent?
- Not always; it can take time
Why is the incidence of manipulation induced stroke difficult to obtain?
- Under-reported in literature
- Delay between manipulation and stroke clouds the correlation and causation
- Dissection may have been in process leading to the practitioner to perform the manipulation
How is the Vertebral Basilar Artery Insufficiency test performed?
- Place patient into end-range rotation with some possible distraction and/or extension.
- Hold for 10 seconds
Is the Vertebral basilar Artery Insufficiency test valid and reliable?
- Not sensitive or specific
What are the 10 signs of VBI (5 Ds, 3 Ns, 1 H, and 1 A)?
- Dizziness
- Drop Attacks
- Diplopia
- Dysarthria
- Dysphagia
- Ataxia
- Nausea
- Numbness
- Nystagmus
- Headache
- Hearing Disturbances
What is dysarthria?
- Slurred speech
What is dysphagia?
- Trouble swallowing
Where is numbness typically felt in patients with VBI?
- Around mouth, or one side of the face or body
What may occur instead of a headache if the VBI is sudden or severe?
- Neck pain
What is an example of the type of hearing disturbance that will be heard in a patient with VBI?
Tinnitus
What may be the ONLY sign in spontaneous cervical artery dissection?
- Pain
What artery do VBI screens not assess that is just as commonly dissected as the vertebral?
- The internal carotid
How strong is the evidence supporting the construct validity of the screening tests to predict the occurrence of VBI?
- No evidence
What are 5 signs in the patient’s history that are risk factors for VBI?
- Hypertension (>180/100)
- Migraine
- Smoking
- Trauma
- Ateriosclerosis
Should premanipulation tests be performed if there is a storng likelihood of VBI?
- No; refer the patient out
Check slide 19
Check slide 19
What is the professional theory of chiropractors?
- The “Law of the Nerve”
What is the professional theory of Physical Therapists?
- Aligned with medicine
How does WHO is treated with PT differ from who is treated with Chiropractors?
PTs ONLY those who fall within the classification system (backed by evidence)
How does WHAT is treated with PT differ from what is treated with Chiropractors?
PTs: Spinal segment hypomobility, and ROM deficits
Chiros: Spinal subluxation
How does WHEN treatment is provided differ between PTs and Chriopractors?
PTs use a spectrum of mobilizations, and use the gentlest mobilization that obtains results within a spectrum of other treatments
Chiros: Manip manip manip
How is VBI traction performed?
- Pt supine
- End range extension for 10 seconds
- End range rotation for 10 seconds
Describe an OA distraction manipulation.
- Cup Pt’s chin, cradle their head with dominant forearm
- Support head below nuchal line with non-dominant hand
- Introduce flexion around an axis through the mastoids
- Introduce side bend to the contralateral side, and rotation to the same side
- Engage the movement barrier, and provide a HVLA in a cranial direction with both hands
Describe OA self-mobilization.
- Guide the upper C spine into flexion with two fingers on the chin with retraction
- Avoid excess lower C-spine motion
- Rotation to about 30 degrees on one side targets the mobilization on one specific joint
Describe a sub-occipital distraction.
- Side bend head on neck to isolate motion to one OA joint
- Press fingers on the occiput until the soft tissue relaxes
- Place dominant hand the on occiput
- Place non-dominant hand on C2 at the laminae
- Stabilize C2 and provide a slight inferior force
- Perform an axial distraction
- Reassess sidebending
Describe AA self-mobilization.
- Flex neck with a chin tuck
- Guide self into an movement barrier of axial rotation
- Perform gentle mobilizations at barrier
- Introduce self muscle energy technique
Describe an upslope manipulation.
- Contact posterolateral aspect of C4
- Grasp chin/ occiput and neck
- Move c-spine segment into the movement barrier of rotation, and add a small amount of side bend
- Thrust to the opposite eye with a combined rotation of the neck
Describe a downslope manipulation.
- Contract posterolateral aspect of C4
- Grasp chin or occiput and neck
- Side bend segment to movement barrier
- Add a small amount of rotation to the opposite side
- Make final adjustments
- Thrust toward opposite shoulder combined with a sidebend
