Manual Therapy Maneuvers for Cervical Spine Do Not Affect Blood Flow to the Brain
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Michael A. Seffinger
Thomas LC, Rivett DA, Bateman G, Stanwell P, Levi CR. Effect of selected manual therapy interventions for mechanical neck pain on vertebral and internal carotid arterial blood flow and cerebral inflow [published online June 27, 2013]. Phys Ther.. doi:10.2522/ptj.20120477.
Manipulation of the cervical spine is rarely associated with serious adverse events involving compromise of the vertebral or internal carotid arteries. A search of the scientific literature, however, yields case studies and case series about patients who had strokes allegedly after receiving cervical manipulation performed by a health care professional.1,2 Although laboratory studies have used ultrasonography to show that certain neck positions can alter vertebral and basilar arterial blood flow velocities, the clinical correlations of these findings have not been proven.3-6 Using magnetic resonance (MR) angiography, Australian researchers Thomas et al sought to examine the effects of selected manual therapy techniques used for mechanical neck pain on blood supply to the brain.
Twenty healthy adult participants (10 men and 10 women; mean [SD] age, 33 [11.9] years [range, 18-65 years]) underwent 3-T MR angiography with their necks in the following positions: neutral, rotation, rotation/distraction, C1-C2 rotation, and distraction. No statistically significantly changes in blood flow to the brain were found for any position, and no individual differences were found in blood flow between participants. In addition, the researchers did not find statistically significant differences in blood flow in any of the 4 cervical arteries for any position from neutral in participants. Each participant had normal anatomic structures. Of note, because this study used only healthy asymptomatic participants and investigated only a short section of the arteries, the results may not be applicable to clinical practice (ie, because of poor external validity).
To limit the risks to participants in the study, volunteers were excluded if they reported any of the following: diagnosed inflammatory joint disease, history of serious cervical spine trauma (eg, fracture), any congenital disorder associated with hypermobility or instability of the upper cervical spine, diagnosed vertebrobasilar artery insufficiency (VBI), claustrophobia or discomfort in confined spaces (a standard contraindication for MR imaging), or any contraindication identified by an MR imaging safety screening questionnaire.
In accordance with Australian Physiotherapy Association guidelines, all participants were assessed for cervical range of motion and tested for VBI prior to MR imaging examination. Participants who exhibited potential symptoms of VBI were excluded from the study; because of the sustained neck positions required for the study, these patients would have been at risk for brain ischemia.
Blood flow to the brain does not appear to be compromised by positions commonly used in manual therapy. The next phase of this study would be to use symptomatic patients and to perform the manual procedures indicated by the clinical findings. Additionally, high-velocity, low-amplitude or spinal manipulative therapy should be employed to determine if these more forceful procedures cause any blood flow differences.
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“The Somatic Connection” highlights and summarizes important contributions to the growing body of literature on the musculoskeletal system's role in health and disease. This section of The Journal of the American Osteopathic Association (JAOA) strives to chronicle the significant increase in published research on manipulative methods and treatments in the United States and the renewed interest in manual medicine internationally, especially in Europe.
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To submit scientific reports for possible inclusion in “The Somatic Connection,” readers are encouraged to contact JAOA Associate Editor Michael A. Seffinger, DO (mseffingerdo@osteopathic.org), or JAOA Editorial Advisory Board Member Hollis H. King, DO, PhD (hollis.king@fammed.wisc.edu).
References
1 Assendelft WJ Bouter LM Knipschild PG . Complications of spinal manipulation: a comprehensive review of the literature. J Fam Pract.1996;42(5):475-480.Suche in Google Scholar
2 Haldeman S Kohlbeck FJ McGregor M . Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation. Spine. 1999;24(8):785-794.10.1097/00007632-199904150-00010Suche in Google Scholar
3 Zaina C Grant R Johnson C Dansie B Taylor J Spyropolous P . The effect of cervical rotation on blood flow in the contralateral vertebral artery. Man Ther.2003;8(2): 103-109.10.1016/S1356-689X(02)00155-8Suche in Google Scholar
4 Arnetoli G Amadori A Stefani P Nuzzaci G . Sonography of vertebral arteries in De Kleyn's position in subjects and in patients with vertebrobasilar transient ischemic attacks. Angiology. 1989;40(8):716-720.10.1177/000331978904000805Suche in Google Scholar
5 Weingart JR Bischoff HP . Doppler sonography of the vertebral artery with regard to head positions appropriate to manual medicine. Manuelle Medizin. 1992;30:62-65.Suche in Google Scholar
6 Thiel H Wallace K Donat J Yong-Hing K . Effect of various head and neck positions on vertebral artery blood flow. Clin Biomech (Bristol, Avon). 1994;9(2):105-110. doi:10.1016/0268-0033(94)90032-9.10.1016/0268-0033(94)90032-9Suche in Google Scholar
© 2013 The American Osteopathic Association
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Artikel in diesem Heft
- Editorial
- A Turning Point for Scholarly Osteopathic Publications
- Letters
- The Somatic Connection: Manual Therapy Is Beneficial for Cervical Radiculopathy
- Response
- Osteopathic Training for MDs
- Correction
- Correction
- Original Contribution
- Prevention of Progressive Back-Specific Dysfunction During Pregnancy: An Assessment of Osteopathic Manual Treatment Based on Cochrane Back Review Group Criteria
- Influence of Manual Therapy on Functional Mobility After Joint Injury in a Rat Model
- Retrospective Medical Record Review of an Osteopathic Manipulative Medicine Hospital Consultation Service
- Evidence-Based Clinical Review
- Dementia: An Evidence-Based Review of Common Presentations and Family-Based Interventions
- Special Communication
- Medicare Reform and Primary Care Concerns for Future Physicians
- Case Report
- I Can't Move My Face! A Case of Bilateral Facial Palsy
- The Somatic Connection
- Manual Therapy Maneuvers for Cervical Spine Do Not Affect Blood Flow to the Brain
- Quantifying Lack of Interexaminer Reliability
- Don't Throw the Baby Out With the Bath Water
- Systematic Review of OMTh for Lower Urinary Tract Symptoms in Women Shows Benefit
- Systematic Review of CAM Approaches to Otitis Media: The Otolaryngology Perspective
- Clinical Images
- Groin Pain Resulting From Spondylodiscitis
