Screening for Vertebrobasilar pathology and upper cervical instability by physical therapists treating neck pain: a retrospective chart review

ABSTRACT

Introduction

Vertebrobasilar vascular pathology and upper cervical ligament instability may contraindicate the use of cervical manual therapy. We examined physical therapists’ documentation of screening for these conditions and hypothesized screening would be more common with specific risk factors and when using manual therapy.

Methods

This chart review included adults with neck pain presenting for outpatient physical therapy from 2015–2021. Exclusions were age<18 and history of cervical spine surgery. Demographics, vertebrobasilar and upper cervical ligament instability screening questions and examination tests, risk factors (i.e. hypertension, whiplash), and use of manual therapy were extracted.

Results

260 patients were included (mean age ± standard deviation 59.6 ± 16.2 years, 70.8% female). Physical therapists infrequently administered vertebrobasilar and upper cervical ligament instability tests (each<14%). Screening questions were generally more common (e.g. headache, visual disturbances; each>13%). There was no significant difference in any frequency of screening method given the presence of hypertension, whiplash, or use of manual therapy (p > .05 for each).

Conclusion

In the present study, physical therapists infrequently documented performance of vertebrobasilar or upper cervical ligament instability screening for adults with neck pain, even in the presence of risk factors or preceding manual therapy. Further research should corroborate these findings and explore reasons for use/avoidance of screening.

KEYWORDS:

• Vertebral Artery
• Spinal manipulation
• Physical examination
• Medical history taking
• Joint instability

Acknowledgements

The authors wish to thank our institution’s Clinical Research Center staff for their assistance in retrieving data for the present study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data used in the present study are not publicly available as they may contain information that could compromise research participants’ privacy.

Additional information

Funding

The authors reported there is no funding associated with the work featured in this article.

Notes on contributors

Anthony Baumann

Anthony Baumann is a physical therapist for University Hospitals and a medical student at Northeast Ohio Medical University purusing orthopedic surgery.

Robert J. Trager

Robert J. Trager is a chiropractor and researcher for University Hospitals.

Deven Curtis

Deven Curtis is a medical student at Northeast Ohio Medical University.

Mingda Chen

Mingda Chen is a medical student at Case Western Reserve University.

Keith Baldwin

Keith Baldwin is an orthopedic surgery and physical therapist at Children’s Hospital of Philadelphia.