When your patients feel dizzy during cervical extension, do you automatically panic and think it is vertebro-basilar insufficiency (VBI)? Well don’t! 

During my manual therapy training almost 3 decades ago, I was taught that vertebral artery tests could pick up VBI. Therefore, if the tests were negative, it was safe to perform cervical manipulations.

This latest systematic review suggests that “…cranio-cervical positioning may not alter blood flow as much as previously expected.”

Basically it is a waste of time and it does not rule out the risk of potential adverse effects following cervical manipulations. Therefore about 15 years ago, I simply stopped performing cervical manipulations.

Reference: Kranenburg R et al Effects of Head and Neck Positions on Blood Flow in the Vertebral, Internal Carotid, and Intracranial Arteries: A Systematic Review. J Orthop Sports Phys Ther. 2019 Jul 5:1-59.
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