Complications associated with health interventions concentrate the mind when associated with debility or loss of life. In rehabilitation medicine, thankfully, as in most areas of modern healthcare in Canada these occurrences are few – though no less impactful when they do occur. Complications associated with neck manipulations are well publicised and give pause to manual therapy for patients with neck pain. A very cursory search of media reports purport to find many a bad outcome to these procedures. However, to advance safety in treatment of neck pain, meaningful research is needed that utilize both new and innovative approaches.
In March of 2017, I was with a team of spine researchers from the University of Alberta led by Dr. Greg Kawchuk that presented preliminary research findings on neck movements and positions and their impact on blood flow to the prefrontal cortex. The conference was an international gathering in Washington DC (DC 2017) that included spine researchers, spine physicians, physiotherapists and chiropractors. Our contribution highlighted work around screening tests that would exclude potential complications from neck manual therapy. We investigated whether eight basic neck movements in and of themselves altered changes in total blood volume in the prefrontal cortex. This area of the brain was chosen because of its importance in general executive function, and we used a relatively new investigative technique known as near infrared spectroscopy to monitor blood volume changes over the area. The investigative technique is essentially a light of specific wavelength that monitors changes in the hemoglobin molecule and their various concentrations associated with the neck movements. After testing 27 graduate students we were able to detect significant changes in blood volume with a combination of neck position and side of the cortex. Specifically, there was significant drop in blood volume with combined right-side flexion and extension, but the greatest reduction occurring was in full flexion. These are preliminary findings but may indicate the beginning of an effective screening device that could rule out those who might be “strokes in progress” when attending for neck treatment.
Notwithstanding, there remains in current practice many safe approaches to treatment of neck pain, particularly those treatments that emphasize postural correction and exercise.
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