Kranenburg R1,2, Tyer R3, Schmitt M4, Luijckx GJ5, Van der Schans C2,6,7, Hutting N8,9, Kerry R10
1Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen, Netherlands, 2University of Groningen, University Medical Center Groningen, Department of Rehabilitation, Groningen, Netherlands, 3Connect Health, Newcastle upon Tyne Intermediate Musculoskeletal Assessment and Treatment Team, Newcastle upon Tyne, United Kingdom, 4Rotterdam University of Applied Science, Research Center Innovations in Care, Rotterdam, Netherlands, 5University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, Netherlands, 6Hanzehogeschool University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen, Netherlands, 7University of Groningen, University Medical Center Groningen, Department of Health Psychology, Groningen, Netherlands, 8HAN University of Applied Sciences, Department of Occupation & Health, Nijmegen, Netherlands, 9Het Centrum, Centre for Physiotherapy & Manual Therapy, Rijen, Netherlands, 10University of Nottingham, Division of Physiotherapy and Rehabilitation Sciences, Nottingham, United Kingdom

Background: Therapeutic interventions at the neck comprise various positions and movements of the cranio-cervical region. The haemodynamic influence of these spinal changes is of essential clinical relevance.

Purpose: To investigate the effects of cervico-cranial positions and movements on haemodynamic parameters (blood flow velocity and/or volume) of cervical and cranio-cervical arteries.

Methods: Four databases were searched. Subsequently, a hand search was performed and experts were consulted. Full text experimental and quasi-experimental research on influence of cervical positions to blood-flow of the vertebral, the internal carotid and the basilar artery. Two independent reviewers selected and extracted the data using the double screening method.

Results: Of the 1378 identified studies the 29 studies were included, and comprised data on 2124 participants. The significant changes that were most commonly identified for the vertebral artery were hemodynamic decrease in maximum rotation (n=8) and combined movement of maximum extension and maximum rotation (n=4). However, most studies mentioned no significant haemodynamic changes during maximum rotation (n=16). A similar pattern was also identified in relation to the haemodynamics of internal carotid and intracranial arteries. Three studies focused on high velocity thrust positioning and movement, all reported no haemodynamic changes. The data synthesized suggest that in most people there is no effect on blood flow during most positions and movements of the cranio-cervical region.

Conclusion(s): Our results suggest that in most people, healthy as well as patients with vascular pathologies, cranio-cervical positions do not alter the cervical blood flow. This includes vascular test positions, pre-manipulative positions and manipulations. Consequently, these results question the rationale of vascular pre-manipulative tests and the causation of vascular events following therapeutic interventions.

Implications: A key emergent implication from this review is that the relationship between cranio-cervical movement and blood flow does not seem to be as obvious as previous data and theory suggested. Although the majority of the included studies shows no significant decrease in end range positions, the data is most consistent in positions with less than 45 degrees rotation. Therefore, it might be wise to choose treatment techniques at first within this range. Furthermore, arterial pre-manipulative tests should be used and interpreted with caution.

Keywords: haemodynamic, blood velocity, cervical spine

Funding acknowledgements: unfunded

Topic: Musculoskeletal: spine; Primary health care; Neurology: stroke

Ethics approval required: No
Institution: Hanzehogeschool University of Applies Sciences
Ethics committee: ICE
Reason not required: it is a SR

All authors, affiliations and abstracts have been published as submitted.

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