A recent statement from the American Heart Association/American Stroke Association (and endorsed by the American Association of Neurological Surgeons and the Congress of Neurological Surgeons) has recommended that chiropractors inform patients of the statistical association between cervical artery dissection and cervical manipulation
Almost all forms of cervical manipulation
have been implicated in these injuries.
All had elective or nonurgently indicated promotion of labor, digital cervical manipulation
, and rapid labor with placental findings of histologically severe intrauterine infection or funisitis, half the time in the absence of classical clinical criteria of chorioamnionitis.
For a better understanding of the relation between cervical manipulation
and vertebrobasilar accidents, insight into the anatomy of the cervical arteries is essential.
Haynes MJ (1994): Stroke following cervical manipulation
Vertebrobasilar vascular accidents with cervical manipulation
A controlled trial of cervical manipulation
57,64,88,89,96,97) However, two systematic reviews have concluded that there is limited to moderate evidence for the use of manual therapies, particularly cervical manipulation
and mobilisation, in the management of this condition.
In a recent Master Class article (Hing et al, 2003) the New Zealand approach to teaching manipulation, in particular cervical manipulation
The mechanical engineering strains experienced by the V3 segment of the VA, the segment which exits from the C2 transverse foramen and loops around C1 into the foramen magnum, during a Diversified-style cervical manipulation
at C2-C4 vertebral levels ranged from 2.
Houle's test, a test that purportedly screens for patients at-risk of experiencing a vertebrobasilar stroke during cervical manipulation
(6), was never used by 70.
Patients with non-mechanical neck pain or contraindications to cervical manipulation
will be excluded.