TY - JOUR
T1 - The immediate effect of atlanto-axial high velocity thrust techniques on blood flow in the vertebral artery
T2 - A randomized controlled trial
AU - Erhardt, Jonathan W.
AU - Windsor, Brett A.
AU - Kerry, Roger
AU - Hoekstra, Chris
AU - Powell, Douglas W.
AU - Porter-Hoke, Ann
AU - Taylor, Alan
N1 - Funding Information:
This study was conducted at Erhardt Physical Therapy and Sports Medicine, an outpatient physical therapy clinic in Portland, OR. We, the authors, affirm that we have no financial affiliation (including research funding) or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript. We received no grant funding. Institutional Review Board approval was obtained from Pacific University, Forest Grove, OR, USA.
Publisher Copyright:
© 2015 Elsevier Ltd.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Background: High velocity thrust (HVT) cervical techniques have been associated with serious vertebral artery (VA) trauma. Despite numerous studies, the nature of this association is uncertain. Previous studies have failed to demonstrate haemodynamic effects on the VA in simulated pre-thrust positions. No study has investigated haemodynamic affects during or immediately following HVT, nor sufficiently controlled for the influence of the thrust. Objectives: To investigate the immediate effects of HVT of the atlanto-axial joint upon haemodynamics in the sub-occipital portion of the vertebral artery (VA3). Design: Randomized Controlled Trial. Method: Twenty-three healthy participants (14 women, 9 men; mean age 40, range 27-69 years of age) were randomly assigned to two groups: an intervention group (MANIP, n=11) received HVT to the atlanto-axial segment whilst a control group (CG, n=12) was held in the pre-manipulative hold position. Colour-flow Doppler ultrasound was used to measure VA3 haemodynamics. Primary outcome measures were peak systolic (PSV) and end diastolic velocities (EDV) of three cardiac cycles measured at neutral (N1), pre-HVT (PreMH), post-HVT (PostMH), post-HVT-neutral (N2) positions. Results: Test-retest reliability for the Doppler measures demonstrated intra-class correlation coefficient (ICC) of 0.99 (95% CI 0.98-1.0) for PSV and 0.91 (95% CI 0.84-0.96) for EDV. Visually, EDV were lower in the MANIP group than in the CONTROL group across the four measurements. However, there were no significantly different changes (at p≤0.01) between the MANIP and CONTROL groups for any measurement variable. Conclusions: HVT to the atlanto-axial joint segment does not affect the haemodynamics of the sub-occipital portion of the vertebral artery during or immediately following HVT in healthy subjects.
AB - Background: High velocity thrust (HVT) cervical techniques have been associated with serious vertebral artery (VA) trauma. Despite numerous studies, the nature of this association is uncertain. Previous studies have failed to demonstrate haemodynamic effects on the VA in simulated pre-thrust positions. No study has investigated haemodynamic affects during or immediately following HVT, nor sufficiently controlled for the influence of the thrust. Objectives: To investigate the immediate effects of HVT of the atlanto-axial joint upon haemodynamics in the sub-occipital portion of the vertebral artery (VA3). Design: Randomized Controlled Trial. Method: Twenty-three healthy participants (14 women, 9 men; mean age 40, range 27-69 years of age) were randomly assigned to two groups: an intervention group (MANIP, n=11) received HVT to the atlanto-axial segment whilst a control group (CG, n=12) was held in the pre-manipulative hold position. Colour-flow Doppler ultrasound was used to measure VA3 haemodynamics. Primary outcome measures were peak systolic (PSV) and end diastolic velocities (EDV) of three cardiac cycles measured at neutral (N1), pre-HVT (PreMH), post-HVT (PostMH), post-HVT-neutral (N2) positions. Results: Test-retest reliability for the Doppler measures demonstrated intra-class correlation coefficient (ICC) of 0.99 (95% CI 0.98-1.0) for PSV and 0.91 (95% CI 0.84-0.96) for EDV. Visually, EDV were lower in the MANIP group than in the CONTROL group across the four measurements. However, there were no significantly different changes (at p≤0.01) between the MANIP and CONTROL groups for any measurement variable. Conclusions: HVT to the atlanto-axial joint segment does not affect the haemodynamics of the sub-occipital portion of the vertebral artery during or immediately following HVT in healthy subjects.
KW - Cervical manipulation
KW - Manual therapy
KW - Vertebral artery
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U2 - 10.1016/j.math.2015.02.008
DO - 10.1016/j.math.2015.02.008
M3 - Article
C2 - 25814193
AN - SCOPUS:84931562509
SN - 2468-8630
VL - 20
SP - 614
EP - 622
JO - Musculoskeletal Science and Practice
JF - Musculoskeletal Science and Practice
IS - 4
ER -