Manipulation Safety Presentation - Idaho State University

Manipulation Safety Adam Squires PT, DPT, Cert SMT, Cert DN Board Certified Specialist in Orthopedic Physical Therapy  Objectives Understand the research on manipulation safety.  Is Manipulation safe? What do you feel are the risks? Have you ever h...

Manipulation Safety Adam Squires PT, DPT, Cert SMT, Cert DN Board Certified Specialist in Orthopedic Physical Therapy  Objectives Understand the research on manipulation safety.  Is Manipulation safe? What do you feel are the risks? Have you ever had a manipulation done on you? What was your experience? Do risks outweigh the benefits?  Safety Concerns generally center on: Damage to the Vertebral and Internal Carotid arteries Fracture Soft tissue damage Artery Safety Anatomy review Evidence  Symons et al (2002) Evaluated strain on the vertebral artery in cadavers during cervical ROM and HVLAT ROM increased strain by 1.2% to12.5% HVLAT increased strain by 6.2% Mechanical failure of the artery did not occur until strains of 139- 162% greater than at rest Concluded HVLAT was unlikely to produce enough force to disrupt a normal vertebral artery.  Cassidy et al (2009) Used databases to find 818 cases of vertebrobasilar artery (VBA) strokes Identified 4 age and sex-matched controls for each stroke Compared if cases (individuals who had a stroke) had seen a chiropractor or PCP 7 or 30 days prior to stroke Compared to if controls had seen a chiropractor or PCP  Cassidy et al (2009) Overall, 4% of both cases and controls saw a chiropractor within 30 days of stroke 53% of cases and 30% of controls saw PCP within 30 days Increased association between chiro and stroke if under 45 years Increased association between PCP and stroke at all ages WHY??? “Patients with head and neck pain due to vertebral artery dissection seek care for these symptoms, which precede more than 80% of VBA strokes.”  Replication Whedon et al 2015 Similar conclusions with Medicare aged population Kosloff et al 2015 Same conclusions with US commercial and Medicare Advantage populations Screening  How do we effectively screen? Thorough history Thomas et al (2015) report 71% of cervical arterial dissection (CAD) cases(90% VBA and 57% for ICA) reported minor mechanical trauma of the head or neck in the last month Individuals with CAD were 60x more likely to have had trauma compared to control group Understand pattern of pain in CAD Screen for red flags present in CAD Taylor and Kerry 2010 ‘System based’ approach to risk assessment of the cervical spine Red Flags – Ns And Ds VAD Internal Carotid Artery Dissection Other Safety Considerations  Fracture Data on fracture risk with manipulation is limited Mostly case studies or case series This is why osteoporosis/osteopenia is a contraindication Certain body areas are at higher risk than others C-spine is less force than T-spine or L-spine Different techniques, different forces https://www.physio-pedia.com/Thoracic_Spine_Fracture  Soft Tissue Injury Most common adverse effect of manipulation Again data are limited in the literature Cleland et al (2009) reported 25% of patients reported an adverse effect (aggravation of symptoms, spasm, stiffness) within 4 hours of Lumbar spine manipulation and resolved within 48 hours https://www.completepaincare.com/patient-education/conditions-treated/muscle-pain-chronic-myalgia/  Is Manipulation safe? Do risks outweigh the benefits?  Objectives Understand the research on manipulation safety. Questions