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