Safety of Neck Manipulation

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The Safety of Manipulation of the Cervical Spine

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Safety of Neck Manipulation

  1. 1. WCPT Conference, Amsterdam Spinal Manipulation – Evidence for Physiotherapist Delivery of Effective Procedures – a focussed symposia Duncan Reid DHSc – Convenor (New Zealand) Tim Flynn PhD (USA) Wayne Hing PhD (NZ) Chris McCarthy PhD (UK) Peiter Westerhuis (Switzerland)
  2. 2. Dr Chris McCarthy PhD, MCSP, FMACPCERVICAL SPINE - GENERAL HEALTHASSESSMENT WCPT Conference, Amsterdam 20 – 23 June 2011
  3. 3. Cervical Spine Health & ManipulationDoes OMPT cause CAD?What are the risk factors for CAD?What are the signs and symptoms?What should be included in consentdiscussions? WCPT Conference, Amsterdam 20 – 23 June 2011
  4. 4. WCPT Conference, Amsterdam20 – 23 June 2011
  5. 5. Contraindications CautionsMultilevel radiculopathy Local InfectionWorsening neurological function Inflammatory diseaseUpper motor neuron lesion Active CancerUnremitting, severe, non-mechanical History of cancerpain Long term steroid use (<3/12)Fracture OsteoporosisSymptoms of a Cervical Artery Dissection Systemically unwellSymptoms of Cervical Instability Hypermobility syndrome Connective tissue disease Risk Factors for Cervical ArteryMoore et al. 2005 CSP Guidelines for Whiplash Dysfunction Risk factors for Cervical Instability WCPT Conference, Amsterdam 20 – 23 June 2011
  6. 6. WCPT Conference, Amsterdam20 – 23 June 2011
  7. 7. •Young (45 years) vertebrobasilar artery territory stroke patients were 5 times morelikely than controls to have visited a chiropractor within 1 week of the event date.•No significant associations were found for those aged 45 years.•The best available estimate of the incidence,, states that for every 100,000 persons45 years of age who receive CMT, approximately 1.3 cases of vertebral arterydissection or occlusion attributable to CMT would be observed within 1 week ofmanipulative therapy. WCPT Conference, Amsterdam 20 – 23 June 2011
  8. 8. WCPT Conference, Amsterdam20 – 23 June 2011
  9. 9. Chiro the same as Physio? WCPT Conference, Amsterdam 20 – 23 June 2011
  10. 10. Lancet Neurol 2009; 8: 668–78 WCPT Conference, Amsterdam 20 – 23 June 2011
  11. 11. WCPT Conference, Amsterdam20 – 23 June 2011
  12. 12. WCPT Conference, Amsterdam20 – 23 June 2011
  13. 13. WCPT Conference, Amsterdam20 – 23 June 2011
  14. 14. Convergence WCPT Conference, Amsterdam 20 – 23 June 2011
  15. 15. WCPT Conference, Amsterdam20 – 23 June 2011
  16. 16. WCPT Conference, Amsterdam20 – 23 June 2011
  17. 17. WCPT Conference, Amsterdam20 – 23 June 2011
  18. 18. OMPT cause CAD? Chiro vs OMPT? Risk Factors and Diagnosis?Objective Cranial Nerves, BP? Consent Uncertainty of risk?equivocal benefit to mobilisation? WCPT Conference, Amsterdam 20 – 23 June 2011

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