Pre-manipulative cervical spine testing and sustained rotation do not influence intracranial hemodynamics: an observational study with transcranial Doppler ultrasound

ABSTRACT

Introduction

Manual joint mobilization and manipulation are recommended therapeutic interventions for people with neck pain. High-velocity thrust and sustained techniques have an uncertain association with serious arterial trauma. The validity of pre-manipulative tests of the cervical spine is often questioned, and the understanding of the effect of head/neck position on blood flow is still incomplete. Most of the evidence concerning hemodynamics in this area relates to extracranial flow (vertebral and carotid artery). Less is understood about the effects on intracranial flow while performing pre-manipulative tests and sustained positions like end of range cervical rotation mobilization. The aim of the study was to assess the influence of commonly used evaluation and treatment positions on intracranial hemodynamic parameters.

Method

A randomized, cross-over observational study using ultrasonography on healthy subjects (n = 19) was conducted to measure hemodynamic parameters (peak systolic velocity and end diastolic maximum) of intracranial arterial systems. Two test positions (sustained pre-manipulative thrust C0-1 and sustained cervical end of range rotation) were compared with a sham position for each test position.

Results

:Neither the sequence of tests performed nor an independent variable (the two positions) had a significant effect (p < 0.05) on peak systolic velocity (PSV) or end diastolic maximum (EDM).

Discussion

No effects from commonly used assessment and treatment of neck positions on hemodynamic parameters were found. This is consistent with previous studies. Further study is indicated on people with symptoms and known pathologies.

KEYWORDS:

• Cervical hemodynamics
• manual testing
• ultrasound
• positional testing
• spinal manual therapy
• validity
• pre-treatment positional testing
• sonography measurement

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors contributions

FM, RK and HP developed the project, the conceptual ideas and manuscript writing. FM was responsible for logistics and recruitment, the performance of pre-manipulative tests/sham positions, and writing at the first stage. MS and DS performed the ultrasound examination and gave a critical reflection of the manuscript. FM, RK and HP were responsible for the corrections and the final writing.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Notes on contributors

Fabian Moll

Fabian is a Physiotherapist and scientific Assistant in the Department of Physiotherapy at the Klinik für Manuelle Therapie (Hopital for Pain Management), Hamm in Germany and works at Physio Consult Fabian Moll (www.fabianmoll.de). He completed his B.Sc. and M.Sc. (OMT) at the Universituy of Applied Science Osnabrück, Germany, and is a final year PhD student at the University of Duisburg-Essen, Germany in medical sciences (medical school) and the Clinic for manual therapy -Hamm, Germany. Fabians research currently focuses on robot-assisted gait training in patients with cerebral palsy.

Mona Sleiman

Mona is a senior Neurologist(MD) at the Agaplesion Bethesda Hospital, Wuppertal, Germany and is specialized neurocardiovascular diseases and Parkinson'ssyndromes.

Dietrich Sturm

Dietrich is a senior Neurologist (MD) at the Agaplesion Bethesda Hospital, Wuppertal, Germany. His personal research interests are peripheral neuropathies, focusing on small-fiber neuropathies.

Roger Kerry

Roger is a Physiotherapist and an Associate Professor in the Division of Physiotherapy & Rehabilitation Sciences, University of Nottingham. With a focus on cervical arterial dysfunction; risks and adverse events of manual therapy, neck pain and headache, clinical reasoning, physical activity and rehabilitation, sports therapy and the Philosophy of Health Science. Roger is a member of International Federation of Orthopaedic Manipulative Physical Therapist (IFOMPT) working group for International Framework for Examination of the Cervical Region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy Intervention 2007-2017. He worked as Clinical Specialist and Extended Scope Practitioner in Orthopaedics before starting as a lecturer at Nottingham and became Honorary Fellow of the Musculoskeletal Association of Chartered Physiotherapists in 2011. His PhD thesis: Causation and Evidence-Based Medicine (supervisor: Professor Stephen Mumford)

Harry von Piekartz

Harry is a Professor at the University of Applied Science in Osnabruck (Germany) (https://www.hs-osnabrueck.de/en/) and is study director of the Master of Science in Musculoskeletal Therapy. He is senior IMTA Teacher of the International Maitland Teacher Association (IMTA) and founder of Cranial Facial Therapy Academy(www.crafta.org) .He successfully completed his Master of Science degree in Physiotherapy at the University of Leuven (Belgium). His thesis was on „The Neurodynamic Testing of the Mandibular Nerve: Reliability and norm-data“(https://www.kuleuven.be/kuleuven/) and). In 2005 he received his PhD in Rehabilitationscience on the Staffordshire University(UK)(https://www.staffs.ac.uk).He directs several musculoskeletal research projects and works part-time in his specialized clinic in Ootmarsum, The Netherlands (www.harryvonpiekartz.com). He published 4 Books in 3 languages and more than 90 peer-reviewed articles in the field of physical therapy, (https://www.researchgate.net/profile/Harry_Piekartz2) and is specialized in neuromusculoskeletal assessment and treatment of head-neck face impairments and pain.