Manual Therapy and Cervical Arterial Dysfunction
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This paper offers a contemporary, evidence-based perspective on the issue of adverse neuro-vascular events related to crvical spine manual therapy. The purpose of this perspective is to challenge traditional thought and practice and to recognize areas where practic and rsearch should develop.
By considering th themes presented in this paper, the clinican can broaden his or hr approach to neurovascular assessment in line with contemporary evidence and thought.
We present information based on clinically relevant questions.
The nature of vertebasilar insufficiency and the utility if pre-treatment testing are examined in light of contemporary evidence.
In addition, we report on internal carotid artery pathology, and the significance of appreciating atherosclerosis in clinical decision-making.
These later two areas are not commonly recongnised within manual therapy litrature, and we suggest that their importance to differntial diagnosis of head and neck pain, as well as estimating treatment related risk, is paramount.
We propose that the term cervical arterial dysfunction is more appropriate than classically used nomenclature. This term refers more accurately and completely to the range of pathologies at different anatomical sites that manual therapists treating patients with head and neck pain are likely to encounter.
Finally, we present a brief review of the medico-legal status pertaining to this area. Although this is English law-related, the themes derived from this section are of interest to all manual therapists.
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