Article

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.

Langue : ANGLAIS