Pre-manipulative cervical spine testing and sustained rotation do not influence intracranial hemodynamics: an observational study with transcranial Doppler ultrasound

J Man Manip Ther. 2023 Feb;31(1):13-23. doi: 10.1080/10669817.2022.2068824. Epub 2022 May 2.


Introduction: Manual joint mobilization and manipulation are recommended therapeutic interventions for people with neck pain. High-velocity thrust and sustained techniques have an uncertain association with serious arterial trauma. The validity of pre-manipulative tests of the cervical spine is often questioned, and the understanding of the effect of head/neck position on blood flow is still incomplete. Most of the evidence concerning hemodynamics in this area relates to extracranial flow (vertebral and carotid artery). Less is understood about the effects on intracranial flow while performing pre-manipulative tests and sustained positions like end of range cervical rotation mobilization. The aim of the study was to assess the influence of commonly used evaluation and treatment positions on intracranial hemodynamic parameters.

Method: A randomized, cross-over observational study using ultrasonography on healthy subjects (n = 19) was conducted to measure hemodynamic parameters (peak systolic velocity and end diastolic maximum) of intracranial arterial systems. Two test positions (sustained pre-manipulative thrust C0-1 and sustained cervical end of range rotation) were compared with a sham position for each test position.

Results: :Neither the sequence of tests performed nor an independent variable (the two positions) had a significant effect (p < 0.05) on peak systolic velocity (PSV) or end diastolic maximum (EDM).

Discussion: No effects from commonly used assessment and treatment of neck positions on hemodynamic parameters were found. This is consistent with previous studies. Further study is indicated on people with symptoms and known pathologies.

Keywords: Cervical hemodynamics; manual testing; positional testing; pre-treatment positional testing; sonography measurement; spinal manual therapy; ultrasound; validity.

Publication types

  • Randomized Controlled Trial
  • Observational Study

MeSH terms

  • Blood Flow Velocity
  • Cervical Vertebrae / diagnostic imaging
  • Hemodynamics
  • Humans
  • Manipulation, Spinal* / methods
  • Rotation
  • Ultrasonography, Doppler, Transcranial
  • Vertebral Artery / diagnostic imaging
  • Vertebral Artery / physiology

Grants and funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.