Manipulative Techniques for the Cervical Spine

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Manipulative Techniques for the Cervical Spine

• Mark Labrecque B.Sc. D.C.

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Learning Objectives

• Provide an overview of the manipulation/
  adjustment of the cervical spine.
• Demonstrate manipulation/ adjustment techniques
  for the cervical spine.

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Manipulation

• Manipulation or intervertebral joint adjustment,
  is a passive manual maneuver during which the
  three joint complex is suddenly carried beyond
  the normal physiological range of movement,
  without exceeding the boundaries of anatomical
  integrity. The usual characteristic is a thrust-
  a brief, sudden, and carefully administered
  impulsion that is given at the end of the
  normal passive range or movement. It is usually
  accompanied by a cracking noise.

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Manipulable Lesion (Joint Dysfunction, Functional
Spinal Lesion, Subluxation)

• Abnormal alignment, movement, and/or function in
  a joint and its surrounding elements that is
  amenable to treatment by manual thrust
  procedures. In this context the term excludes
  states of hypermobility or instability.

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Indications

• Correction of joint dysfunction symptoms
• Pain, muscle hypertonicity, decrease ROM, joint
  restriction
• Mobilization, soft tissue techniques not
  successful, plateaued improvement

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Effects of Manipulation

• Mechanical
• improved motion
• Soft tissue
• decreased tone, adhesions
• Neurological
• Local- capsule mechanoreceptors including pain
  control and decrease muscle tone.
• Widespread- improvement of faulty movement
  patterns
• Psychological
• Laying on of hands
• Finding the spot

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Contraindications (summary only)

• Absolute to all cervical treatment
• Obvious medical emergencies
• Symptoms of neurovascular impairment
• Neck or occipital pain unlike anything previously
  experienced
• Severe and persistent headache- sudden never
  experienced before.
• Frank bone or joint disease
• Infection, inflammatory
• Pathologic conditions
• Fracture, instability, cancer
• Patient cannot tolerate the treatment

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Risks of Manipulation

• Soreness following treatment is common
• Rare unforeseen adverse events have been
  reported- spinal cord compression, facet edema,
  disk herniation, long thoracic nerve palsy and
  diaphragm paralysis related to phrenic nerve
  trauma.
• Most serious risk event is a Posterior
  Circulation Stroke, affecting the vertebral
  artery.
• This is a very rare eventcalculation of risk is
  difficult.

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Risks of Manipulation

• Risk of Vertebrobasilar Stroke and Chiropractic
  Care
• Spine 2008 33 S176- S183
• Key Points
• Vertebrobasilar artery stroke is a rare event in
  the population
• There is an association between vertebrobasilar
  artery stroke and chiropractic visits in those
  under 45 years of age.
• There is also an association between
  vertebrobasilar artery stroke and use of primary
  care physician visits in all age groups.
• We found no evidence of excess risk of VBA stroke
  associate chiropractic care.
• The increased risks of vertebrobasilar artery
  stroke associated with chiropractic and physician
  visits is likely explained by patients with
  vertebrobasilar dissection-related neck pain and
  headache consulting both chiropractors and
  primary care physicians before their VBA stroke.

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Now What?

• Early recognition is now the challenge
• No reliable provocative screening tests for
  vertebral artery competency
• Look for

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Listen for what?

• Slurred speech
• Giddiness
• Change in voice pattern
• Lack of context in speech
• Inappropriate reaction to situations
• I have a pain in my neck and (or) head unlike
  anything I have ever had before

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Informed Consent

• Information about the risks and benefits of the
  treatment you are offering and the options
  available.
• Chiropractors Association of Sask. requires a
  signed consent form for all patients.

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Cervical Manipulation Techniques

• Factors that influence manipulative procedures
• Age
• Acute or chronic problem
• Physical condition of the patient
• Clinicians size and ability
• Effectiveness of previous therapy, present
  therapy or both
• There are many manipulation procedures
• Supine
• Prone
• Sitting
• Decision- line of drive, force, upper/lower
  cervical spine.

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How to Analyze the Adjustment

• Does it follow normal biomechanics?
• It is within patient tolerance -- aka is it
  painful?
• Does it match the palpation?
• Is the adjustment utilizing the best physics
  (force development)?
• Is the adjustment the best for the patient and
  provider's body type?
• Is the adjustment protective to the providers
  longevity?
• Source Terry Elder D.C.

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Demo

• Cervical spine manipulation / adjustment.

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Further Information

• www.ccachiro.org
• Summary- Bone and Joint Decade Task Force on Neck
  pain and its Associated Disorders
• Canadian Chiropractic Clinical Practice
  Guideline Evidence- based treatment of adult
  neck pain not due to whiplash- September 2005

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• Thank you