Effect of selected manual therapy interventions for mechanical neck pain on vertebral and internal carotid arterial blood flow and cerebral inflow

Thomas L.C., Rivett D.A., Bateman G., Stanwell P. and Levi C.R. (2013) Effect of selected manual therapy interventions for mechanical neck pain on vertebral and internal carotid arterial blood flow and cerebral inflow. Physical Therapy, 93 11: 1563-1574. doi:10.2522/ptj.20120477


Author Thomas L.C.
Rivett D.A.
Bateman G.
Stanwell P.
Levi C.R.
Title Effect of selected manual therapy interventions for mechanical neck pain on vertebral and internal carotid arterial blood flow and cerebral inflow
Journal name Physical Therapy   Check publisher's open access policy
ISSN 0031-9023
1538-6724
Publication date 2013-11-01
Year available 2013
Sub-type Article (original research)
DOI 10.2522/ptj.20120477
Volume 93
Issue 11
Start page 1563
End page 1574
Total pages 12
Place of publication Alexandria, United States
Publisher American Physical Therapy Association
Subject 3612 Physical Therapy, Sports Therapy and Rehabilitation
Formatted abstract
Background. Manual therapy of the cervical spine has occasionally been associated with serious adverse events involving compromise of the craniocervical arteries. Ultrasound studies have shown certain neck positions can alter craniocervical arterial blood flow velocities; however, findings are conflicting. Knowledge about the effects of neck position on blood flow may assist clinicians in avoiding potentially hazardous practices.
Objective. The purpose of this study was to examine the effects of selected manual therapeutic interventions on blood flow in the craniocervical arteries and blood supply to the brain using magnetic resonance angiography (MRA).
Design. This was an experimental, observational magnetic resonance imaging study.
Method. Twenty adult participants who were healthy and had a mean age of 33 years were imaged using MRA in the following neck positions: neutral, rotation, rotation/distraction (similar to a Cyriax manipulation), C1-C2 rotation (similar to a Maitland or osteopathic manipulation), and distraction.
Results. The participants were imaged using 3T MRA. All participants had normal vascular anatomy. Average inflow to the brain in neutral was 6.98 mL/s and was not significantly changed by any of the test positions. There was no significant difference in flow in any of the 4 arteries in any position from neutral, despite large individual variations.
Limitations. Only individuals who were asymptomatic were investigated, and a short section of the arteries only were imaged.
Conclusions. Blood flow to the brain does not appear to be compromised by positions commonly used in manual therapy. Positions using end-range neck rotation and distraction do not appear to be more hazardous to cerebral circulation than more segmentally localized techniques.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Health and Rehabilitation Sciences Publications
 
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Created: Wed, 26 Feb 2014, 20:09:19 EST by Ms Kate Rowe on behalf of School of Health & Rehabilitation Sciences