We suggest the term cervical arterial dysfunction (CAD). It is hoped that this information will be used in conjunction with existing guidelines and knowledge in developing as complete a clinical assessment as possible.īased on the concepts presented here, we propose a revision of the nomenclature by which we refer to arterial problems of the cervical spine. This paper provides a contemporary, evidence-based overview of relevant information to facilitate clinicians understanding of the effect of cervical MT on blood flow. Although a number of countries have produced guidelines to assist the clinician in their assessment process 5, there is still debate on the utility of such protocols 6, 7. There is a lack of consensus on the best way to assess for the possibility of adverse events occurring as a result of treatment. Although numerous types of adverse events have been documented, e.g., injury to the intervertebral disc, ligaments, nerves etc., the cause for most concern is arguably cerebro-vascular events related to stresses on the arterial vessels around the neck the most common of such events is arguably vertebrobasilar insufficiency (VBI). Despite evidence demonstrating potential efficacy of this intervention 2, 3, there are known risks that have been associated with some aspects of cervical MT 4.
Manual therapy (MT) is a commonly used intervention for the management of cervico-cranial pain 1. Although this is English law-related, the themes derived from this section are of interest to all manual therapists. Finally, we present a brief review of the medico-legal status pertaining to this area. This term refers more accurately and completely to the range of pathologies at different anatomical sites that manual therapists treating patients with head and neck pain are likely to encounter. We propose that the term cervical arterial dysfunction is more appropriate than classically used nomenclature. These later two areas are not commonly recognized within manual therapy literature, and we suggest that their importance to differential diagnosis of head and neck pain, as well as estimating treatment related risk, is paramount. In addition, we report on internal carotid artery pathology, and the significance of appreciating atherosclerosis in clinical decision-making. The nature of vertebrobasilar insufficiency and the utility of pre-treatment testing are examined in light of contemporary evidence. We present information based on clinically relevant questions. By considering the themes presented in this paper, the clinician can broaden his or her approach to neurovascular assessment in line with contemporary evidence and thought. The purpose of this perspective is to challenge traditional thought and practice and to recognize areas where practice and research should develop. This paper offers a contemporary, evidence-based perspective on the issue of adverse neurovascular events related to cervical spine manual therapy.
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