Cervical Spine Treatment Safety Tips

Screening of the cervical spine for safety prior to performing techniques should be routine for most manual physical therapists. Over my practice in the past 23 years, I have learned many ways to screen structures, particularly the vertebral artery. It has been well established that the vertebral artery is at most risk during the performance of manual therapy to the cervical spine. It is also established that the risk is relatively low measured at 0.75-2.9 incidents per 100,000 people.

To ensure safety, the International Federation of Orthopeadic Manual Therapists (IFOMPT) published a “Framework” for assessing the cervical spine prior to treatment. IFOMPT has recently released its 2020 update entitled, “International Framework for Examination of the Cervical Region for potential of vascular pathologies of the neck prior to Orthopaedic Manual Therapy (OMT) Intervention”.

Some of the highlights of the article are the following:

Advancing from 2012 advice we have moved from vertebral artery testing to assessment for cervical artery disease to now assessing vascular pathologies of the cervical spine. This may seem like playing with words, but provocative positional testing for the cervical spine is no longer recommended and does not increase safety in practice.
What is recommended is:
- Taking vital signs including blood pressure.
- Examining that carotid artery.
- Performing a thorough neurological examination including cranial nerve assessment.
- One test does not ensure you are safe in treating the cervical spine, and it starts with a good assessment.

At NAIOMT we have always emphasized safety through clinical reasoning and the framework from IFOMPT is well worth reading to provide a guide for safe clinical practice.

A video worth watching is Senior Faculty Bill Temes and his discussion of assessment of the cervical spine for vascular pathologies, which fits well into the IFOMPT framework.