Manual joint mobilization and manipulation are beneficial interventions for neck pain, but high-velocity thrust and sustained techniques are linked to serious arterial trauma. The reliability of pre-manipulative tests of the cervical spine is not clear, and the impact of head and neck position on blood flow is still not fully understood.

The existing research primarily focuses on the impact of head and neck positions on extracranial blood flow, specifically in the vertebral and carotid arteries. However, the influence of pre-manipulative tests and sustained positions, such as end-of-range cervical rotation mobilization, on intracranial blood flow remains poorly understood.

Recently (May 2022), Moll et al. conducted a cross-over randomized observational study to evaluate the impact of frequently used assessment and treatment positions on intracranial hemodynamic parameters.

In the research study, Moll et al. used ultrasonography to measure hemodynamic parameters of intracranial arterial systems in healthy individuals (n = 19). The study compared two test positions (sustained pre-manipulative thrust C0-1 and sustained cervical end-of-range rotation) with a sham position for each test position. The aim was to assess the influence of commonly used evaluation and treatment positions on peak systolic velocity and end-diastolic maximum of the intracranial arterial systems.

The researchers found that there was no significant effect (p < 0.05) observed on peak systolic velocity (PSV) or end diastolic maximum (EDM) of the intracranial arterial systems, neither by the sequence of tests performed nor by the two positions. In other words, both the order of the tests conducted and the two test positions (sustained pre-manipulative thrust C0-1 and sustained cervical end-of-range rotation) were not found to have a significant impact (p < 0.05) on the peak systolic velocity (PSV) or end diastolic maximum (EDM) of the intracranial arterial systems.

The absence of hemodynamic parameter effects from commonly used neck assessment and treatment positions is consistent with previous research. However, further investigation is needed to study individuals with known pathologies and symptoms.

Reference:

Moll, F., Sleiman, M., Sturm, D., Kerry, R., & von Piekartz, H. (2023). Pre-manipulative cervical spine testing and sustained rotation do not influence intracranial hemodynamics: an observational study with transcranial Doppler ultrasound. Journal of Manual & Manipulative Therapy, 31(1), 13-23.