Manual therapy and cervical arterial dysfunction, directions for the future: a clinical perspective

Area of Science:

• Neurology
• Orthopedics
• Vascular Medicine

Background:

• Adverse neurovascular events are a concern with cervical spine manual therapy.
• Traditional approaches may not fully encompass current evidence and clinical considerations.

Purpose of the Study:

• To provide a contemporary, evidence-based perspective on neurovascular events associated with cervical spine manual therapy.
• To challenge existing thought and practice, identifying areas for development in clinical practice and research.
• To enhance clinicians' neurovascular assessment strategies for head and neck pain patients.

Main Methods:

• Review of contemporary evidence regarding vertebrobasilar insufficiency and pre-treatment testing.
• Examination of internal carotid artery pathology and atherosclerosis in clinical decision-making.
• Proposal of revised nomenclature for anatomical pathologies encountered in manual therapy.

Main Results:

• Contemporary evidence suggests a need to broaden neurovascular assessment beyond traditional considerations.
• Internal carotid artery pathology and atherosclerosis are significant factors in differential diagnosis and risk assessment for head and neck pain.
• The term "cervical arterial dysfunction" is proposed as a more accurate and comprehensive descriptor.

Conclusions:

• Clinicians should adopt a broader approach to neurovascular assessment, integrating contemporary evidence.
• Recognizing internal carotid artery pathology and atherosclerosis is crucial for manual therapists treating head and neck pain.
• The proposed term "cervical arterial dysfunction" better reflects the spectrum of pathologies relevant to manual therapy practice.