A ‘system based’ approach to risk assessment of the cervical spine prior to manual therapy

This paper presents a clinical overview and update of cervical arterial dysfunction (CAD) for osteopaths and other clinicians who treat patients presenting with cervical pain and headache syndromes. An overview of a ‘system based’ approach to the concept of vertebrobasilar arterial insufficiency (VBI) is covered, with reference to assessment procedures recommended by commonly used guidelines. We suggest that the evidence supporting contemporary practice remains limited and present a more holistic approach to considering cervical arterial dysfunction. This ‘system based’ approach considers typical pain patterns and clinical progressions of both vertebrobasilar, and internal carotid arterial pathologies. Attention to the risk factors, pathomechanics and haemodynamics of arterial dysfunction is also given. We suggest that consideration of the information provided in this updated ‘Masterclass’ will enhance clinical reasoning with regard to differential diagnosis of cervical pain syndromes and prediction of serious adverse reactions to treatment.