vbi and cad testing

[SigMik]

Dear DrDamien. You're welcome, and I hope they'll might add something to your already wide base of knowledge. You're right on with what I tried to convey in my previous post - almost anyone are in reality in risk for complications due to a manip... Or assessment... Imagine how tensed up and un-relaxed the patient would be after the extensice CV-testing and after getting an informed consent of possible complications? Think that will cause some nocebo?? And as the articles reports, even if you've done all the pre-work due to the protocols as suggested, it's still in reality a risk... What obviously complicates it more is that the protocols indirectly (or even with that first casestudy in the first article) indicate that any assessment (not only cardiovascular screening) or work on the neck is potentially a hazard... For my part after getting through the CAD dilemma, I take an even stronger responsibility as a health care practitioner, in doing a thorough general health screening, on all patients and very aware on whom I choose to manip. But - it is important to put this into perspective as well - it's potentially dangerous to exercise too or even take a dump if you have any indications of a cardiovascular risk profile. This would probably put the manips in an even better perspective - http://www.guardian.co.uk/science/20...ncture-needles

I don't know if there's any chiro's or osteopaths in here, but it would be interesting to hear their take on this issue.

You say you're generally always take the hands off approach when it comes to the neck, what do you mean with that? I'm thinking it's a big difference in being careful and considerate when it comes to the neck and to use hands off approach. Do you ever manip the neck?

Ziggy

[Dr Damien]

Dear SigMik

What I mean by hands off is whatever can be achieved by active exercises, I would advocate that before I decide to manipulate the neck.

Maybe clarifying terms but give a better understanding so we all are on the same wavelength. manipulation is often described as the high velocity low applitude thrust that we give joints to gain range after we have reached the pathological limit. If by manipulation you mean this, then I do not manipulate the neck...I will always go for active exercises first, mobilization using traction or segmental mobs of grades B pressure... treatment can be slow but the effect is always the same as having a quick manip...

However if you mean" manipulate" as most doctors often use to describe any form of manual therapy (including massage) then I do manipulate the neck...I desist from high velocity movements only because I know the dangers. 98% of my clients are hypertensive, all of them are usually on statins, at least half of them have to be on wafarin, most of them have had some form of stroke before, anatomically the all have forward necks, and at least three quarters of them suffer from dizziness, a small percentage of them have an aneurysm somewhere, three quarters of them have heart issues and at least half are diabetic.

If the come to me with neck problems...manipulation is the last thing on my mind...i would take the hands off approach with these clients, using heat therapy as well as active exercises combined with massage to gain the same effect (it often takes forever). I would work on their postures as well with sound advice. This works for the majority and for me its safer...the most I would do if these are not taking effect would be to use grades B mobs...and I would always avoid the rotary components...This the client can do themselves...with gentle controlled and sustained traction and grades B mobs of segments, it is easier for them to completer the rotations as exercise...however because I always tell them to be wary of pain...we often get slow rehabs but usually effective...

have i ever manipulated the neck? yes, when I worked in outpatients back in my country, these clients were usually fit...and the risk for them was often very low...
Im talking military men and/or sports clients...cab drivers, office workers who sit on the computers for long hours...

Im too aware of the dangers to put the clients at risk...at the same time im too chicken to find out what could go wrong...

The other thing is often what most people may not consider...the possibilty of a latent systemic arthropathy i.e R.A, some people dont know they are beginning to have these symptoms...the danger of manipualting such necks is too great...

Cheers SigMik