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Joint Manipulation: Cervical Spine
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Joint Manipulation: Cervical Spine

Joint manipulations for the cervical spine. Types of manipulations, manipulations vs. mobilizations of the spine and cervical spine. Optimal intervention for forward head, shoulders elevate, arms fall, cervicogenic headache, radiculopathy, posture, jaw, shoulder, and elbow dysfunction. The risk of adverse events, accuracy vs sensitivity, screening, reliability, and validity of cervical spine manips.

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Course Description: Cervical Spine Manipulation

Introduction

This course describes joint manipulation techniques for the cervical spine (neck manipulation). Various synonyms and definitions have been used to describe the term "manipulation". The Brookbush Institute uses one conventional definition of the term "manipulations;" implying low-amplitude (relatively small motions), high-velocity (quick) techniques, intended to target and reduce the stiffness of specific joints or segments, that exhibit a decrease in passive accessory range of motion (a.k.a. stiffness during arthrokinematic motion and specifically glide or slide). Research does imply that manipulations likely affect multiple joints simultaneously; however, the Brookbush Institute asserts that efforts to target the stiffest joints or segments will increase the likelihood that the stiffest segments are included in the "multiple joints" affected.

The Brookbush Institute has carefully selected manipulation techniques with the intent to increase the probability of practitioner success. That is, techniques have been chosen that are relatively easy to teach, reliably improve outcomes, and are the most commonly used. The Brookbush Institute does not wish to assert that these manipulation techniques are the only techniques that are effective, and/or that these are the best techniques for every outcome measure. It is possible that a highly complex, and/or advanced technique, may result in better outcomes, or that a particular pathology is better addressed with a relatively rarely used technique.

Note, that the term "mobilization" is reserved for low-velocity techniques that are taught in a separate set of courses.

This course includes mobilization techniques that intend to improve excessive stiffness of the cervical spine and upper thoracic spine stiffness, improve spine range of motion (ROM) restrictions, and reduce cervicothoracic and upper extremity dysfunction. For example, cervical dysfunction has been correlated with lateral epicondylitis, and manipulations of the cervical spine have been correlated with reduced pain and improved function, such as increased grip strength. These techniques may also be used in an integrated approach for cervicothoracic dysfunction, and upper body dysfunction (UBD) including cervicogenic headache, shoulder impingement syndrome (SIS), lateral epicondylitis (tennis elbow), chronic thoracic pain, chronic neck pain, and acromioclavicular dysfunction, and postural dysfunctions including rounded shoulder posture, forward head posture, thoracic kyphosis, or an anterior pelvic tilt. Some evidence and clinical outcomes even suggest that addressing cervical dysfunction and forward head posture can improve long-term outcomes for low back pain patients.

The techniques in this course are recommended for all clinical human movement professionals (physical therapists, physical therapy assistants, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) to develop an evidence-based, systematic, integrated, patient-centered, patient-centered, and outcome-driven approach.

Techniques Covered in this Course:

Additional Joint Mobilization Courses

For an introduction to joint mobilizations and manipulations:

Pre-approved credits for:

Pre-approved for Continuing Education Credits for:

This Course Includes:

  • AI Tutor
  • Study Guide
  • Text and Illustrations
  • Audio Voice-over
  • Research Review
  • Technique Videos
  • Sample Routine
  • Practice Exam
  • Pre-approved Final Exam

Course Study Guide: Joint Manipulation: Cervical Spine

Introduction
1 Sub Section

Research Summary

Cervical Spine Manipulations
6 Sub Sections

Systemic Response

Cervical Manipulation and Other Interventions

Risk of Adverse Effects

Manipulation versus Mobilization

Video Demonstration
3 Sub Sections

Sample Intervention (Chronic Neck Pain)

Bibliography

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    • Cervicogenic Headache
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    • Cervical Manipulation and Shoulder
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    • Cervical Manipulation and Elbow
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    • Cervical Manipulation and Jaw
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    • Systemic Response (including 13, 20, 22, 25, 27, 28, )
  38. Win, N. N., Jorgensen, A. M. S., Chen, Y. S., & Haneline, M. T. (2015). Effects of upper and lower cervical spinal manipulative therapy on blood pressure and heart rate variability in volunteers and patients with neck pain: a randomized controlled, cross-over, preliminary study. Journal of chiropractic medicine, 14(1), 1-9.
  39. Goertz, C. M., Salsbury, S. A., Vining, R. D., Long, C. R., Pohlman, K. A., Weeks, W. B., & Lamas, G. A. (2016). Effect of spinal manipulation of upper cervical vertebrae on blood pressure: results of a pilot sham-controlled trial. Journal of manipulative and physiological therapeutics, 39(5), 369-380.
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    • Cervical Manipulation versus Other Interventions
  55. Escortell, E. M., Lebrijo, G. P., Pérez, Y. M., del Barco Asúnsolo, A., Riesgo, R. F., & Saa, C. R. (2008). Randomized clinical trial for primary care patients with neck pain: manual therapy versus electrical stimulation. Atencion primaria, 40(7), 337-343.
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    • Cervical Manipulation and Other Interventions
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  69. Akhter et al. demonstrated that both manual therapy and exercise improved pain and function related to non-specific neck pain, however, the best results were exhibited by the combined intervention group.
  70. Evans, R., Bronfort, G., Nelson, B., & Goldsmith, C. H. (2002). Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain. Spine, 27(21), 2383-2389.
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  72. Evans, R., Bronfort, G., Schulz, C., Maiers, M., Bracha, Y., Svendsen, K., … & Transfeldt, E. (2012). Supervised exercise with and without spinal manipulation performs similarly and better than home exercise for chronic neck pain: a randomized controlled trial. Spine, 37(11), 903-914.
  73. Maiers, M., Bronfort, G., Evans, R., Hartvigsen, J., Svendsen, K., Bracha, Y., … & Grimm, R. (2014). Spinal manipulative therapy and exercise for seniors with chronic neck pain. The Spine Journal, 14(9), 1879-1889.
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  75. Boline, P. D., Kassak, K., Bronfort, G., Nelson, C., & Anderson, A. V. (1995). Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. Journal of Manipulative and Physiological Therapeutics, 18(3), 148-154.
  76. Nelson, C. F., Bronfort, G., Evans, R., Boline, P., Goldsmith, C., & Anderson, A. V. (1998). The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. Journal of manipulative and physiological therapeutics, 21(8), 511-519.
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  78. Li, C., Zhang, X. L., Ding, H., Tao, Y. Q., & Zhan, H. S. (2007). Comparative study on effects of manipulation treatment and transcutaneous electrical nerve stimulation on patients with cervicogenic headache. Zhong xi yi jie he xue bao= Journal of Chinese integrative medicine, 5(4), 403-406.
  79. Puentedura, E. J., Landers, M. R., Cleland, J. A., Mintken, P., Huijbregts, P., & Fernandez-De-Las-Peñas, C. (2011). Thoracic spine thrust manipulation versus cervical spine thrust manipulation in patients with acute neck pain: a randomized clinical trial. journal of orthopaedic & sports physical therapy, 41(4), 208-220.
    • Risk of Adverse Effects
  80. Magarey, M. E., Rebbeck, T., Coughlan, B., Grimmer, K., Rivett, D. A., & Refshauge, K. (2004). Pre-manipulative testing of the cervical spine review, revision and new clinical guidelines. Manual Therapy, 9(2), 95-108.
  81. Stevinson, C., Honan, W., Cooke, B., & Ernst, E. (2001). Neurological complications of cervical spine manipulation. Journal of the Royal Society of Medicine, 94(3), 107-110.
  82. Haldeman, S., Carey, P., Townsend, M., & Papadopoulos, C. (2002). Clinical perceptions of the risk of vertebral artery dissection after cervical manipulation: the effect of referral bias. The Spine Journal, 2(5), 334-342.
  83. Dvořák, J., Loustalot, D., Baumgartner, H., & Antinnes, J. A. (1993). Frequency of complications of manipulation of the spine. European Spine Journal, 2(3), 136-139.
  84. Thiel, H. W., Bolton, J. E., Docherty, S., & Portlock, J. C. (2007). Safety of chiropractic manipulation of the cervical spine: a prospective national survey. Spine, 32(21), 2375-2378.
  85. Rothwell, D. M., Bondy, S. J., & Williams, J. I. (2001). Chiropractic manipulation and stroke. Stroke, 32(5), 1054-1063.
  86. Kranenburg, H. A., Schmitt, M. A., Puentedura, E. J., Luijckx, G. J., & Van der Schans, C. P. (2017). Adverse events associated with the use of cervical spine manipulation or mobilization and patient characteristics: a systematic review. Musculoskeletal science and practice, 28, 32-38.
  87. Cagnie, B., Vinck, E., Beernaert, A., & Cambier, D. (2004). How common are side effects of spinal manipulation and can these side effects be predicted?. Manual therapy, 9(3), 151-156.
  88. Paanalahti, K., Holm, L. W., Nordin, M., Asker, M., Lyander, J., & Skillgate, E. (2014). Adverse events after manual therapy among patients seeking care for neck and/or back pain: a randomized controlled trial. BMC musculoskeletal disorders, 15(1), 77.
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  90. Puentedura et al. analyzed 10 reported cases of injury following thoracic manipulation, noting that spinal cord injury and pneumothorax have occurred.
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    • Mobilization versus Manipulation
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    • Additional Research
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