High-Velocity Thrust to the Atlantoaxial Joint Does Not Increase Mechanical Stress on the Vertebral Artery
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Christle C. Guevarra
Erhardt J, Windsor BA, Kerry R, et al. The immediate effect of atlanto-axial high velocity thrust techniques on blood flow in the vertebral artery: a randomized controlled trial [published online March 2, 2015]. Man Ther. doi:10.1016/j.math.2015.02.008.
In 2009, the American Osteopathic Association’s House of Delegates reaffirmed their 2004 position paper1 on osteopathic manipulative treatment to the cervical spine, endorsing the use of high-velocity, low-amplitude thrust by osteopathic physicians but calling for further research on the risk of vertebro-basilar accidents. In 2013, Thomas et al2 found no alteration in blood flow in the brain with passive neck maneuvers used in cervical mobilization or before thrust of the cervical spine.
Using Doppler ultrasonography, Erhardt et al conducted a randomized controlled trial examining the effects of high-velocity thrust (HVT) techniques, performed by a licensed physical therapist, of the atlantoaxial joint on hemodynamics of the suboccipital portion of the vertebral artery (VA3).
Twenty-three healthy adult participants (14 men and 9 women; mean [SD] age, 40 [12.6] years [range, 27-69 years]) were randomly assigned to an intervention group (n=11), in which HVT was applied to the atlantoaxial segment, or a control group (n=12), in which participants were held in the premanipulative hold position. Doppler ultrasonography was used to measure VA3 hemodynamics. Exclusion criteria included a history of known vertebral artery anomalies, hypoplasia, various spinal conditions, and more. Participants were also excluded if the investigators were unable to visualize VA3 on ultrasonography. The primary outcome measures were peak systolic and end diastolic velocities, which were measured at neutral, pre-HVT, post-HVT, and post-HVT-neutral positions.
Within-group comparison revealed no statistically significant differences between any cervical positions on peak systolic or end diastolic velocities for both the control and intervention groups, suggesting no statistically significant differences in blood flow velocity between HVT therapy and the static premanipulative hold position. Between-group comparison revealed no statistically significant changes between the control and intervention groups for any measurement variable, demonstrating no changes in blood flow velocity after HVT therapy. Because this study used only healthy patients, it remains uncertain as to how HVT therapy affects blood flow in diseased, inherently weak, or hypoplastic vessels. However, this article strengthens the research supporting cervical manipulation’s safety in healthy patients.
References
1. American Osteopathic Association position paper on osteopathic manipulation treatment of the cervical spine. American Academy of Osteopathy website. http://files.academyofosteopathy.org/MemberResourceGuide/AOAPositionPaperOMTCervicalSpine.pdf. Accessed April 2, 2015.Search in Google Scholar
2. Thomas LC ,RivettDA,BatemanG,StanwellP,LeviCR. Effect of selected manual therapy interventions for mechanical neck pain on vertebral and internal carotid arterial blood flow and cerebral inflow.Phys Ther.2013;93(11):1563-1574. doi:10.2522/ptj.20120477.10.2522/ptj.20120477Search in Google Scholar PubMed
© 2015 American Osteopathic Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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Articles in the same Issue
- IN MY VIEW
- Imaging Technology and Somatic Dysfunction Theory
- ORIGINAL CONTRIBUTION
- Variations in the Diagnosis and Treatment of Somatic Dysfunction Between 4 Osteopathic Residency Programs
- Lymphatic Pump Treatment as an Adjunct to Antibiotics for Pneumonia in a Rat Model
- MEDICAL EDUCATION
- Canadian DOs: International Expansion of Osteopathic Medical Education North of the Border
- SPECIAL COMMUNICATION
- Research Dissemination: Guiding the Novice Researcher on the Publication Path
- CASE REPORT
- Pulmonary Lymphangitic Carcinomatosis From Metastatic Gastric Adenocarcinoma: Case Report
- Spontaneous Pneumomediastinum in a Pediatric Patient After a 1600-m Run: Case Report and Literature Review
- THE SOMATIC CONNECTION
- Systematic Review Challenges Efficacy of Pediatric OMT
- High-Velocity Thrust to the Atlantoaxial Joint Does Not Increase Mechanical Stress on the Vertebral Artery
- Manual Manipulation Is More Effective Than Mechanical-Assisted Manipulation in Managing Low Back Pain
- CLINICAL IMAGES
- Saddle Pulmonary Embolus
