Podcast
Questions and Answers
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), what percentage of cervical arterial dissection (CAD) cases involved minor mechanical trauma to the head or neck within the last month?
How much more likely were individuals with CAD to have experienced trauma compared to the control group, according to the study by Thomas et al. (2015)?
How much more likely were individuals with CAD to have experienced trauma compared to the control group, according to the study by Thomas et al. (2015)?
Which area of the spine requires the least amount of force for a fracture to occur?
Which area of the spine requires the least amount of force for a fracture to occur?
What is the most frequently reported adverse effect following spinal manipulation?
What is the most frequently reported adverse effect following spinal manipulation?
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What percentage of patients in Cleland et al.'s (2009) study reported adverse effects within 4 hours of lumbar spine manipulation?
What percentage of patients in Cleland et al.'s (2009) study reported adverse effects within 4 hours of lumbar spine manipulation?
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What are the primary safety concerns related to manipulation?
What are the primary safety concerns related to manipulation?
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What was the primary finding of Symons et al (2002) regarding high-velocity, low-amplitude thrust (HVLAT) manipulation?
What was the primary finding of Symons et al (2002) regarding high-velocity, low-amplitude thrust (HVLAT) manipulation?
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According to Cassidy et al (2009), what percentage of both stroke cases and controls had visited a chiropractor within 30 days of the stroke incident?
According to Cassidy et al (2009), what percentage of both stroke cases and controls had visited a chiropractor within 30 days of the stroke incident?
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What was the key observation regarding the association between healthcare visits (chiropractor or primary care physician) and stroke in Cassidy et al (2009)?
What was the key observation regarding the association between healthcare visits (chiropractor or primary care physician) and stroke in Cassidy et al (2009)?
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What is the main reason patients with vertebral artery dissection might seek care from a chiropractor or PCP?
What is the main reason patients with vertebral artery dissection might seek care from a chiropractor or PCP?
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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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What range of strain increase was observed on the vertebral artery during range of motion (ROM) exercises in the Symons et al (2002) cadaver study?
What range of strain increase was observed on the vertebral artery during range of motion (ROM) exercises in the Symons et al (2002) cadaver study?
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How much additional strain did HVLAT induce on the vertebral artery compared to the resting state in the Symons et al (2002) study?
How much additional strain did HVLAT induce on the vertebral artery compared to the resting state in the Symons et al (2002) study?
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Study Notes
Manipulation Safety
- The presentation is on the safety of manipulation techniques in physical therapy.
- The presenter is Adam Squires, a board-certified specialist in orthopedic physical therapy.
- The presentation covers objectives, safety concerns, evidence, screening methods, and other considerations.
Objectives
- The objective is to understand the research on manipulation safety.
Is Manipulation Safe?
- Questions to consider regarding manipulation safety include: What are the potential risks? Has the patient experienced manipulation before? What was the experience like? Do the risks outweigh the benefits?
Safety
- The primary concerns regarding manipulation center on potential damage to the vertebral and internal carotid arteries, fractures, and soft tissue damage.
Artery Safety
- The presentation highlights artery safety as a critical aspect of manipulation.
- Images or diagrams may visually represent vertebral and carotid arteries in the neck region.
Anatomy Review
- An anatomical review of the neck area is presented, showing the location of critical arteries and vertebral structures.
- Visual aids such as anatomical models are likely included for better understanding.
Evidence
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Symons et al (2002) studied strain on vertebral arteries during cervical manipulation and high-velocity, low-amplitude techniques (HVLAT).
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Their findings indicated that routine cervical range-of-motion (ROM) increased strain by 1.2-12.5%. HVLAT increased strain by 6.2%.
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Mechanical failure of the artery didn't occur unless strains exceeded 139%-162% that at rest.
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The study concluded HVLAT is unlikely to damage a healthy vertebral artery.
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Cassidy et al (2009) used databases to evaluate 818 cases of vertebrobasilar artery (VBA) strokes.
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They identified matched controls and compared historical chiropractic or physician visits to the strokes.
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Rates of visits within 30 days of stroke were similarly low for both patients and controls.
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Increased association between chiropractic visits within 30 days were seen in patients under 45 years old, with similar patterns for PCP office visits.
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Pain may lead patients to seek chiropractic assistance, which may increase this association.
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Whedon et al (2015) and Kosloff et al (2015) supported the prior studies.
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Results were comparable using US commercial and Medicare Advantage populations and Medicare-aged populations.
Screening
- A thorough patient history is crucial for effective screening.
- Thomas et al(2015) reported that 71% of cervical arterial dissection (CAD) cases had minor mechanical trauma to the head or neck within one month.
- Understand the common pain patterns in CAD.
- Screen for specific red flags associated with cervical artery dissection.
Red Flags – Ns and Ds
- (Refer to table for classic signs/symptoms of vertebrobasilar insufficiency [VBI])
- Possible associated neuroanatomy is present relating to the signs and symptoms.
VAD
- Non-ischemic symptoms may precede ischemic events related to vertebral artery dissection (VAD)
- Symptoms may occur from days to weeks prior to ischemic event.
- Ischemic and non-ischemic signs/symptoms are presented in table(refer to table)
Internal Carotid Artery Dissection
- (Refer to table for non-ischemic and ischemic symptoms)
- Common signs/symptoms in internal carotid artery dissection are presented in a table.
Other Safety Considerations
- Fracture data in relation to manipulation is limited and largely presented as case studies or case series.
- Osteoporosis/osteopenia is considered a contraindication for manipulation due to increased fracture risk in certain areas (like the C-spine).
- Different manipulation techniques may exert different levels of force, impacting the risk of injury in various areas of the spine.
Soft Tissue Injury
- Soft tissue injury is the most common adverse effect of manipulation.
- Cleland et al (2009) found that 25% of patients reported adverse effects 4 hours after lumbar spine manipulation, but these resolved within 48 hours.
- Literature on this topic is limited.
Is Manipulation Safe?
- The question concerning whether risks outweigh the benefits remains an open topic.
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Description
Explore the safety of manipulation techniques in physical therapy through this comprehensive presentation by Adam Squires, a certified orthopedic specialist. Understand the key objectives, safety concerns, and research findings regarding manipulation safety, including potential risks and considerations involving vertebral and carotid arteries.
