Week 4 Tutorial- High Velocity Thrust Manipulations Of The Spine

Question 1

What are contraindications to spinal manipulations

Answer 1

• Upper motor neuron lesion
• Spinal cord compromise
• Multi-level; spinal nerve/nerve root compromise (cervical)
• Deteriorating neurological status
• Intense, unremitting, non-mechanical pain
• Constant night pain (stopping patient from falling asleep)
• Recent trauma to relevant region, especially head and neck
• Craniovertebral ligament instability
• Vertebrobasilar insufficiency or internal carotid pathology

Question 2

What are precautions to spinal manipulations

Answer 2

• Cervical spine anomaly
• Congenital collagenous condition (e.g. Down syndrome)
• Connective tissue disease
• Currently or recently active cancers
• First episode before age 18 or after age 55
• Hypermobility disorder
• Inflammatory joint disease (e.g. RA or AS)
• Local infection
• Osteoporosis
• Prolonged or recent use of steroid injection
• Recent or frequent manipulation
• Systemic illness
• Throat infection (cervical)

Question 3

What are risk factors for cervical arterial dysfunction (CAD)

Answer 3

• Past history of trauma to cervical spine/blood vessels
• History of migraine type headaches
• Hypertension
• Hypercholesterolemia/hyperlipidemia
• History of smoking
• Cardiac disease, vascular disease, previous cerebrovascular accident or transient ischaemic attack
• Diabetes mellitus
• Blood clotting disorders/altered blood properties
• Anti-coagulant therapy
• Long-term use of steroids
• History of smoking
• Recent infection
• Immediately post-partum
• Trivial head or neck trauma
• Absence of a plausible mechanical explanation for symptoms

Question 4

What are risk factors for upper cervical instability (UCI)

Answer 4

• History of trauma
• Throat infection
• Congenital collagenous compromise (e.g. Down’s syndrome)
• Inflammatory arthritides (e.g. RA or AS)
• Recent neck/head/dental surgery