Abstract
Background: Neck manipulation occasionally causes stroke after trauma to the vertebral or internal
carotid artery. Premanipulative tests involving cervical spine rotation or extension
have been recommended to detect patients at risk of neurovascular ischemia. However,
the effect of these procedures on extracranial blood flow is not well established,
and their validity is thus controversial. Objective: To determine the effect of premanipulative tests involving cervical spine rotation
or extension on vertebral artery and internal carotid artery blood flow parameters.
Design: Two-group experimental study. Subjects: Twenty subjects consisting of 16 patients treated with physiotherapy and four volunteers.
Methods: Subjects were tested with a recommended premanipulative protocol by both an independent
physiotherapist and an investigator. One group consisted of 10 subjects with signs
or symptoms indicative of neurovascular ischemia on premanipulative testing, with
10 subjects with no signs or symptoms indicative of neurovascular ischemia on premanipulative
testing comprising the second group. Hemodynamic measurements for both vertebral and
both internal carotid arteries were taken by use of duplex Doppler ultrasonography
with color-flow imaging with the subjects in the following positions: neutral, end-range
extension, 45 degrees contralateral rotation, end-range contralateral rotation, and
combined end-range contralateral rotation/extension. Results: The reliability of premanipulative testing was supported. Significant changes in
flow velocity of the vertebral artery (and to a lesser extent of the internal carotid
artery) were shown in end-range positions involving rotation and extension. No meaningful
significant differences were found between the two groups. Conclusions: Screening procedures that use rotation and extension may be useful tests of the adequacy
of collateral circulation. A larger study is needed to determine whether subjects
testing positive significantly differ from those testing negative. (J Manipulative
Physiol Ther 1999;22:368–75)
Keywords
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Article info
Publication history
Received:
October 1,
1998
Footnotes
☆Submit reprint requests to Darren A. Rivett, School of Physiotherapy, University of Otago, PO Box 56, Dunedin, New Zealand. E-mail: [email protected]
☆☆Funding for this study was provided by the School of Physiotherapy, University of Otago.
Identification
Copyright
© 1999 JMPT. Published by Elsevier Inc. All rights reserved.
