Changes in Vertebral Artery Blood Flow Following Various Head Positions and Cervical Spine Manipulation

The immediate effect of atlanto-axial high velocity thrust techniques on blood flow in the vertebral artery: A randomized controlled trial

“…Bowler et al reported no changes in response to HVT. No significant flow or velocity changes were reported by Quesnele et al (2014) with peak velocity at the VA3 section in neutral at 16.7 cm/s. However, this was measured with phase-contrast MRI and calibrated accordingly.…”

“…Placing the cervical spine in a simulated HVT position has not been shown to adversely affect blood flow in vertebral arteries (Licht et al, 1998;Licht et al 1999;Bowler et al, 2011). A recent MRI flow study reported no changes in flow after the execution of HVT (Quesnele et al, 2014). Information pertaining to blood flow during a cervical HVT technique may enhance the clinical decision making of the manual physical therapist.…”

The effect of end-range cervical rotation on vertebral and internal carotid arterial blood flow and cerebral inflow: A sub analysis of an MRI study

“…In an elderly cohort with existing cerebrovascular disease (Weintraub and Khoury 1995), sustained end-range rotation, up to 13 minutes, produced significant decrease in flow volume in the contralateral VA and provoked VBI symptoms. In contrast, two small studies of healthy young adult males demonstrated no difference in VA flow with neck rotation (Mawera, Hillen et al 1998, Quesnele, Triano et al 2014. A recent examination of both VA and ICA blood flow response to neck movement in healthy adults (Thomas, Rivett et al 2013) similarly found no significant difference in flow for a number of neck positions, including rotation.…”

“…Attempts to quantify blood flow changes in the VAs on neck rotation, with the premise that large changes in flow might indicate greater biomechanical stress on the artery, have yielded conflicting findings. Some studies showing reduced flow on contralateral rotation, some with ipsilateral and others no change in either direction, sometimes despite positive VBI tests (Thiel, Wallace et al 1994, Haynes 1996, Rivett, Sharples et al 1999, Haynes and Milne 2001 Sakaguchi, Kitagawa et al 2003, Zaina, Grant et al 2003, Mitchell, Keene et al 2004, Sultan, Hartshorne et al 2009, Bowler, Shamley et al 2011, Quesnele, Triano et al 2014. Of the few studies that have examined blood flow in the ICAs, similarly conflicting findings have emerged (Sultan, Hartshorne et al 2009, Bowler, Shamley et al 2011.…”

“Cervical Vertigo-Pathophysiology and Management: An Update”

“…They postulated that this hypothesis could explain why some patients suffering from cervical pain have vertigo while others do not and thought migraine could be a link between cervical pain and cervicogenic vertigo (22). On the one hand, the association between migraine and vertigo has been well documented in the literature and the term "migraine-associated vertigo" has been widely recognized by the international com-munity (71)(72)(73)(74). A study carried out by Selby and Lance (75) found one-third of people with migraine experience vertigo.…”