This document summarizes a presentation given at the WCPT Conference in Amsterdam on cervical spine health and manipulation. The presentation addressed several questions: whether osteopathic manipulative therapy (OMT) can cause cervical artery dissection (CAD), how chiropractic compares to OMT, what the risk factors and signs/symptoms of CAD are, and what should be included in consent discussions given the uncertainty of risks and potentially equivocal benefits of cervical mobilization. The presentation discussed contraindications and cautions for cervical manipulation and reviewed studies on risk of vertebrobasilar artery stroke associated with chiropractic manipulation.

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. Dr Chris McCarthy PhD, MCSP, FMACP
CERVICAL SPINE - GENERAL HEALTH
ASSESSMENT
WCPT Conference, Amsterdam
20 – 23 June 2011

3. Cervical Spine Health &
Manipulation
Does OMPT cause CAD?
What are the risk factors for CAD?
What are the signs and symptoms?
What should be included in consent
discussions?
WCPT Conference, Amsterdam
20 – 23 June 2011

4. WCPT Conference, Amsterdam
20 – 23 June 2011

5. Contraindications Cautions
Multilevel radiculopathy Local Infection
Worsening neurological function Inflammatory disease
Upper motor neuron lesion Active Cancer
Unremitting, severe, non-mechanical History of cancer
pain Long term steroid use (<3/12)
Fracture Osteoporosis
Symptoms of a Cervical Artery Dissection Systemically unwell
Symptoms of Cervical Instability Hypermobility syndrome
Connective tissue disease
Risk Factors for Cervical Artery
Moore et al. 2005 CSP Guidelines for Whiplash Dysfunction
Risk factors for Cervical Instability
WCPT Conference, Amsterdam
20 – 23 June 2011

6. WCPT Conference, Amsterdam
20 – 23 June 2011

7. •Young (45 years) vertebrobasilar artery territory stroke patients were 5 times more
likely 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 persons
45 years of age who receive CMT, approximately 1.3 cases of vertebral artery
dissection or occlusion attributable to CMT would be observed within 1 week of
manipulative therapy. WCPT Conference, Amsterdam
20 – 23 June 2011

8. WCPT Conference, Amsterdam
20 – 23 June 2011

9. Chiro the same as Physio?
WCPT Conference, Amsterdam
20 – 23 June 2011

10. Lancet Neurol 2009; 8: 668–78
WCPT Conference, Amsterdam
20 – 23 June 2011

11. WCPT Conference, Amsterdam
20 – 23 June 2011

12. WCPT Conference, Amsterdam
20 – 23 June 2011

13. WCPT Conference, Amsterdam
20 – 23 June 2011

14. Convergence
WCPT Conference, Amsterdam
20 – 23 June 2011

15. WCPT Conference, Amsterdam
20 – 23 June 2011

16. WCPT Conference, Amsterdam
20 – 23 June 2011

17. WCPT Conference, Amsterdam
20 – 23 June 2011

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