Manipulation of the Cervical Spine

Original Editor - Riccardo Ugrin

Top Contributors - Riccardo Ugrin and Blessed Denzel Vhudzijena  

Introduction

The cervical spine is often a cause or a contributing cause for pain in the upper limb, in the head or in the dorsal region of the back. It is important to analyse the effectiveness and the efficiency of the manipulation techniques for manage pain. The safety and the contraindications of manipulation of the cervical spine were deeply analysed in the last decades, in order to proof the High Velocity Low Amplitude Thrust (HVLAT) as a technique to provide pain relief.

Contraindications

• Fractures of vertebrae: it is possible to have a fracture of vertebrae if a major trauma occours (car accident or an head injury) with cervical pain in standing position and with/without nervous system symptoms to the limbs. To make diagnosis of fracture to the cervical spine a X-ray evaluation is needed. With symptoms and without recent X-ray evaluations it is possible to discriminate the risk of fractures applying the Canadian C-Spine Rule (CCR): the CCR is a decision-making tool used to determine when radiography should be utilized in patients following trauma. It is not applicable in non-trauma cases, if the patient has unstable vital signs, acute paralysis, known vertebral disease or previous history of Cervical Spine surgery and age <16 years. 
• Recent cervical surgery: an HVLAT can force the arthrodesis between vertebrae causing paralysis. Even
• Rheumatoid arthritis: the sinovial joints are affected in Rheumatoid arthritis. The trasverse ligament of the atlas is in close relationship with the atlanto-axial joint. The degeneration of the sinovial tissue of the joint could affect the trasverse ligament. Because of that the dens is no longer anchored and an HVLAT can move up the cervical spine, causing paralysis.
• Vascular Pathologies of the Neck:

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