Podcast
Questions and Answers
What percentage of cervical arterial dissection (CAD) cases involved minor mechanical trauma to the head or neck within the last month, according to Thomas et al (2015)?
What percentage of cervical arterial dissection (CAD) cases involved minor mechanical trauma to the head or neck within the last month, according to Thomas et al (2015)?
How much more likely were individuals with CAD to have experienced trauma compared to the control group?
How much more likely were individuals with CAD to have experienced trauma compared to the control group?
Which spinal region generally requires less force for fracture?
Which spinal region generally requires less force for fracture?
What is the most common adverse effect of spinal manipulation?
What is the most common adverse effect of spinal manipulation?
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What percentage of patients in Cleland et al (2009)'s study reported an adverse effect within 4 hours of lumbar spine manipulation?
What percentage of patients in Cleland et al (2009)'s study reported an adverse effect within 4 hours of lumbar spine manipulation?
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What is the primary focus of safety concerns regarding manipulation?
What is the primary focus of safety concerns regarding manipulation?
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According to Symons et al (2002), how much strain did HVLAT place on the vertebral artery?
According to Symons et al (2002), how much strain did HVLAT place on the vertebral artery?
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In Symons et al (2002) Cadaver study, what percentage of strain caused mechanical failure of the vertebral artery?
In Symons et al (2002) Cadaver study, what percentage of strain caused mechanical failure of the vertebral artery?
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What was the key comparison made in the Cassidy et al (2009) study regarding vertebrobasilar artery (VBA) strokes?
What was the key comparison made in the Cassidy et al (2009) study regarding vertebrobasilar artery (VBA) strokes?
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What percentage of both cases and controls in the Cassidy et al (2009) study saw a chiropractor within 30 days of a stroke?
What percentage of both cases and controls in the Cassidy et al (2009) study saw a chiropractor within 30 days of a stroke?
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What was the primary finding regarding PCP visits in the Cassidy et al (2009) study?
What was the primary finding regarding PCP visits in the Cassidy et al (2009) study?
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Why might there be an association between healthcare visits (chiropractor or PCP) and subsequent strokes?
Why might there be an association between healthcare visits (chiropractor or PCP) and subsequent strokes?
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Which studies replicated the findings of Cassidy et al. (2009)?
Which studies replicated the findings of Cassidy et al. (2009)?
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Study Notes
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.
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Description
This presentation explores the safety of manipulation procedures in physical therapy, led by expert Adam Squires. Key topics include potential risks associated with manipulation and the importance of considering both benefits and safety measures related to anatomical structures. Attendees will gain insights into safe practices and personal reflections on manipulation experiences.
