Manipulation Safety and Risks

Manipulation Safety

• Manipulation safety research is the focus
• Risks and benefits of manipulation are crucial considerations
• Potential risks include damage to the vertebral and internal carotid arteries, fractures, and soft tissue damage.

Is Manipulation Safe?

• Questions about the risks of manipulation are raised
• Personal experiences with manipulation are examined
• The balance between risks and benefits is questioned

Safety Concerns

• Research concerns generally center around potential damage to the vertebral and internal carotid arteries.
• Fractures and soft tissue damage are also noted as concerns.

Artery Safety

• Artery safety focuses on the importance of understanding artery anatomy for safe manipulation.

Anatomy Review

• The anatomy of the vertebral arteries is presented through diagrams.

Evidence

• Symons et al (2002) study assessed cervical spine ranges of motion and high-velocity, low-amplitude thrusts (HVLAT) on vertebral artery strain in cadavers
• Results indicated minor strain increases with ROM and HVLAT, but no mechanical failure of the artery was found until significant (139-162%) strain, suggesting safety with a typical range.

Cassidy et al (2009)

• Examined databases for 818 vertebrobasilar artery (VBA) stroke cases.
• Age and sex-matched controls are utilized in this study.
• Cases were compared to controls to determine if patients had seen a chiropractor or PCP in the 7 or 30 days prior to the stroke.
• A correlation was found between chiropractic care and stroke if age was under 45.
• A stronger correlation was also found between general PCP visits and stroke among all ages.

Replication

• Whedon et al (2015) and Kosloff et al (2015) replicated earlier studies in other populations,
• Reaching the same conclusions about the effect of chiropractic care on VBA strokes in the Medicare and US commercial populations.

Screening

• A thorough history is crucial for effective screening.
• Thomas et al (2015) note that 71% of cervical arterial dissection (CAD) cases (90% VBA and 57% ICA) had reported minor head/neck trauma in the prior month.
• Patients with CAD were significantly more likely to have reported recent trauma compared to controls.
• Understanding patterns of neck pain associated with CAD and screening for red flags are further highlighted

Red Flags - Considerations

• Table 1 details classic signs and symptoms of possible vertebrobasilar insufficiency (VBI) with associated neuroanatomy.
• It lists various associated neuroanatomy components related to each sign, like dizziness (lower vestibular nuclei) , and drop attacks (reticular formation).

VAD

• Table 2 details possible non-ischemic and ischemic signs and symptoms of vertebral artery dissection (VAD).

Internal Carotid Artery Dissection

• Table 3 presents clinical features of ICA dissection, including both non-ischemic and ischemic signs and symptoms.
• This table also notes that non-ischemic symptoms precede ischemic (cerebral or retinal) symptoms in ICA dissection, similar to other conditions.

Other Safety Considerations

• Data regarding fracture risk related to manipulation is limited to mostly case studies and series.
• Osteoporosis or osteopenia are contraindications to certain manipulation techniques due to higher risk.
• C-spine manipulation offers less risk than T-spine or L-spine manipulation.
• Different manipulation techniques create different forces

Soft Tissue Injury

• Soft tissue injuries are the most common adverse effect of manipulation.
• Cleland et al (2009) reported 25% of patients experienced adverse effects (such as spasm, stiffness, aggravation of symptoms) within 4 hours of lumbar spine manipulation, resolving by 48 hours.

Is Manipulation Safe? - Revisited

• A final consideration of whether manipulation risks outweigh benefits is presented, emphasizing the need for careful evaluation of patient cases.

Objectives - Revisited

• Research on manipulation safety remains an ongoing area of study.