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Is there a role for premanipulative testing before cervical manipulation?

P B Licht1, H W Christensen, P F Høilund-Carlsen

  • 1Department of Clinical Physiology and Nuclear Medicine, Odense University Hospital, Odense, Denmark. peter.licht@ouh.dk

Journal of Manipulative and Physiological Therapeutics
|April 20, 2000
PubMed
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A positive premanipulative test for cervical spine manipulation may not be an absolute contraindication. Normal vertebral artery blood flow on Doppler ultrasound suggests patients can proceed with treatment safely.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Orthopedics

Background:

  • Cervical spine manipulation is common for biomechanical dysfunction.
  • Cerebrovascular accidents are a rare concern following manipulation.
  • Premanipulative tests for vertebral artery issues are controversial in their effectiveness.

Purpose of the Study:

  • To assess vertebral artery blood flow in patients with positive premanipulative tests.
  • To determine if chiropractors would treat patients with normal vascular tests despite positive premanipulative findings.

Main Methods:

  • Prospective study in a university hospital vascular laboratory.
  • Chiropractors referred patients with positive premanipulative tests.
  • Vertebral artery blood flow measured using color duplex sonography.

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Main Results:

  • No significant difference in vertebral artery flow velocities was found with head positioning in patients with positive tests.
  • 19 of 21 chiropractors would treat patients if vascular examination was normal.
  • 8 patients treated without complications; 6 became symptom-free, 2 improved.

Conclusions:

  • A positive premanipulative test is not an absolute contraindication for cervical spine manipulation.
  • Referral for vertebral artery duplex examination is suggested for reproducible positive tests.
  • Normal duplex flow indicates eligibility for cervical manipulation.