Manual therapy and cervical artery dysfunction: Identification of potential risk factors in clinical encounters

Cervical artery dysfunction is a reported potential risk associated with manual therapy applied to the cervical and cervicothoracic spine. While a variety of physical examination tests have been advocated to screen patients who may be at risk of adverse events during or after manipulation, their clinical utility is limited. This paper provides an overview of the literature and current thinking with regard to risk assessment and clinical action related to the application of manual and exercise therapy for the cervical and upper thoracic spine.