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Chiropractic Research Review

Is Cervical Premanipulative Testing Necessary?

Despite fears of cerebrovascular accidents (CVAs) following manipulation, less than 200 cases appear in reviews of literature from the last century. Most of these cases represent patients sustaining damage to areas of the brain that receive blood supply from the vertebral artery; 10 CVAs have been reported involving the internal carotid artery.

Premanipulative tests are used in hopes of identifying patients who may be at risk for a CVA; it is thought that positive tests are caused by positional obstruction of the vertebral artery - a contraindication to cervical adjustments. However, there is controversy regarding these tests and their ability to truly identify an obstructed artery.

The authors have published previous research on patients with positive premanipulative tests who demonstrated no difference in various aspects of blood flow in the vertebral arteries. This study focused on the internal carotid arteries of 11 of these same patients, measuring blood flow in different cervical positions using color duplex sonography.

Two patients were excluded from final analysis because repeated premanipulative testing failed to reproduce symptoms. In the other nine subjects, no significant differences in peak or mean flow velocity were observed in the internal carotids at the different head positions. Blood flow never stopped in any patient, even though all had tested positive in the premanipulative tests.

Conclusion: Positive premanipulative cervical tests may not effectively predict flow velocity or speed in the vertebral or carotid arteries, and may be of little clinical use, according to the authors. "One cannot rule out that pathological conditions other than mechanical vascular damage could be responsible for the symptoms evoked by a premanipulative test ...our results were merely indicative and should not be taken as a proof of the safety (or harmlessness) of cervical manipulative therapy."

Licht PB, Christensen HW, Høilund-Carlsen PF. Carotid artery blood flow during premanipulative testing. Journal of Manipulative and Physiological Therapeutics 2002:25(9), pp. 568-572. www.mosby.com/jmpt

Chiropractic Research Review

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