Manipulation Safety in Physical Therapy

Manipulation Safety

• The presentation is on manipulation safety in physical therapy.
• The presenter is Adam Squires, PT, DPT, Cert SMT, Cert DN, a board-certified specialist in orthopedic physical therapy.
• The objectives are to understand the research on manipulation safety.
• The presentation includes considerations on safety for manipulation procedures, addressing risks, experiences, and benefits.

Is Manipulation Safe?

• The presentation considers whether manipulation is a safe procedure.
• Potential risks include damage to the vertebral and internal carotid arteries, fractures, and soft tissue damage.
• The presenter asks if risks outweigh the benefits of manipulation.
• The presenter encourages personal reflection on risks and past experiences with manipulation procedures.

Artery Safety

• The presentation emphasizes the importance of artery safety during manipulation procedures.
• Relevant anatomical structures and their relationship to potential injury are highlighted.

Anatomy Review

• The presentation shows diagrams of the vertebral and internal carotid arteries in relation to the cervical spine.
• Clear illustrations aid in understanding the location and vulnerability of these arteries.
• The anatomy review clarifies the location and structure of arteries.

Evidence

• The presentation examines research to determine manipulation safety.
• Studies and researchers, like Symons et al. (2002) and Cassidy et al. (2009), are mentioned.
• Key findings of Symons et al. (2002) included that increased strain by cervical range of motion (ROM) and high-velocity, low-amplitude thrust (HVLAT) techniques were not enough to cause mechanical failure. Furthermore, the HVLAT techniques were unlikely to cause a disruption of the normal vertebral artery.
• Key findings of Cassidy et al. (2009) showed an increased association between chiropractic visits and stroke, especially in younger patients, and a noticeable increase between general physician (PCP) visits and stroke at all ages.
• Replication of findings from these studies are mentioned in further research by Whedon et al. (2015) and Kosloff et al. (2015).
• Evidence demonstrates a lack of sufficient evidence for determining if manipulation techniques are safe or not.

Screening

• The presentation discusses how to effectively screen for potential risks associated with manipulation.
• History taking is important because Thomas et al. (2015) found that 71% of cervical arterial dissection cases had minor trauma to the head and neck within the prior month.
• The importance of examining pain patterns and red flags in cervical arterial dissection (CAD) is highlighted.

Red Flags - N and Ds

• The table provides a table of signs and symptoms associated with vertebrobasilar insufficiency (VBI) and their corresponding neuroanatomy.

VAD

• The presentation discusses presentations of vertebral artery dissection (VAD).
• Non-ischemic symptoms can precede ischemic events by a few to several weeks.
• The presentation distinguishes between non-ischemic and ischemic signs and symptoms.

Internal Carotid Artery Dissection

• Presentation highlights clinical features of internal carotid artery (ICA) dissection.
• Non-ischemic signs and symptoms may precede ischemic events by a few to several weeks, and symptoms can be local or ischemic.

Other Safety Considerations

• The presentation addresses other factors affecting manipulation safety.
• Fracture risk during manipulation is considered limited.
• Osteoporosis/osteopenia is frequently a contraindication to manipulation due to increased risk of fracture.
• Specific locations of the spine are more vulnerable to fractures than others.
• Different manipulation techniques result in different forces.

Fracture

• There are limited data on fracture risk with manipulation.
• Mostly case studies exist.
• Osteoporosis/osteopenia is a contraindication for manipulation due to elevated fracture risk in certain areas.
• The cervical spine is less prone to fracture compared to the thoracic or lumbar spine.
• Techniques and forces varying during manipulation are discussed.

Soft Tissue Injury

• Soft tissue injury is the most common adverse effect of manipulation, with approximately 25% of patients experiencing adverse effects (aggravation of symptoms, spasm, stiffness) within 4 hours of lumbar spine manipulation, resolving within 48 hours.
• Cleland et al (2009) reported this data.
• Limited data exist.

Is Manipulation Safe?

• The discussion concludes by questioning whether the benefits of manipulation outweigh the risk.

Objectives (Repeat)

• The presentation revisits the objectives, focusing on understanding the research on manipulation safety.