Effects of Head and Neck Positions on Blood Flow in the Vertebral, Internal Carotid, and Intracranial Arteries: A Systematic Review

Kranenburg, Rik; Tyer, Rob; Schmitt, Maarten A.; Luijckx, Gert Jan; Schans, Cees van der; Hutting, Nathan; Kerry, Roger

doi:10.2519/jospt.2019.8578

Cited by 11 publications

(5 citation statements)

References 53 publications

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“…As a different opinion, another study examining VA and ICA blood flow after manipulation in individuals with chronic neck pain showed that blood flow parameters did not change [ 26 ]. It is stated that there is no change in head and neck blood flow after different head positions and cervical manipulation and that cervical interventions can be used safely [ 35 ]. Studies examining head and neck blood flow in the literature often question whether mobilization and manipulation interventions can be applied safely.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Cervical Mobilization with Clinical Pilates Exercises on Pain, Muscle Stiffness and Head and Neck Blood Flow in Cervicogenic Headache: Randomized Controlled Trial

Uzun,

İkidağ,

Ekmekyapar Fırat

et al. 2024

Medicina

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Background and Objectives: Physiotherapy approaches are used to eliminate the problems caused by cervicogenic headache (CHA), known as secondary headache associated with the structures of the upper cervical region. This study aimed to investigate the effects of cervical mobilization (CM) with clinical Pilates exercises (CPE) on pain, muscle stiffness and head–neck blood flow in CGH. Materials and Methods: A total of 25 patients participated in this randomized controlled study and were randomized into either the CM group or the CM+CPE group. All treatment methods were applied 3 days a week for 6 weeks. The outcome measure was headache intensity and frequency, the number of analgesics, muscle stiffness and vertebral artery (VA) and internal carotid artery (ICA) blood flow. Headache intensity was measured by a visual analogue scale, muscle stiffness by a myotonometer and blood flow by Doppler US. Evaluations were repeated after 6 weeks of treatment. Within-group comparisons were made by the Wilcoxon signed rank test, and between-group comparisons were made by the Mann–Whitney U test. Results: After treatments in the two groups, headache intensity and frequency and the number of analgesics decreased, the muscle stiffness of the suboccipital, upper trapezius and sternocleidomastoid (SCM) muscles decreased, and the blood flow of the ICA and VA increased (p < 0.05). There was a significant difference between the groups in terms of headache intensity (p = 0.025) and muscle stiffness in SKM (p = 0.044) in favor of the CM+CPE group. Conclusions: Non-pharmacological treatment approaches have an important role in CHA related to the upper cervical region. This study suggests that it would be beneficial to add CM in combination with CPE to the non-pharmacological treatment of patients with CHA.

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Section: Discussionmentioning

confidence: 99%

The Effects of Cervical Mobilization with Clinical Pilates Exercises on Pain, Muscle Stiffness and Head and Neck Blood Flow in Cervicogenic Headache: Randomized Controlled Trial

Uzun,

İkidağ,

Ekmekyapar Fırat

et al. 2024

Medicina

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“…This report highlights that examination findings of directional preference (e.g., features that vary per spinal position) should be interpreted with caution and are not necessarily diagnostic of a degenerative spinal disorder [ 9 ]. Symptoms related to the cervical arteries may also be modified with position [ 10 ], thereby yielding a confusing picture if both spinal and vascular disorders are present. As the patient’s reflex tests normalized with cervical flexion, the chiropractor considered a diagnosis of cervical spinal stenosis.…”

Section: Discussionmentioning

confidence: 99%

An Adult Patient With Acute Ischemic Stroke and Carotid Stenosis Presenting to a Chiropractor: A Case Report

deBuhr¹,

Trager²,

Tao³

2023

Cureus

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A 59-year-old male, with a recent history of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, presented to a chiropractor with a one-week history of numbness in the right upper and lower extremity that was triggered by neck movement, and lightheadedness/dizziness. On examination, the chiropractor noted limited, painful cervical spine range of motion, right upper extremity weakness, patellar hyperreflexia, positive Hoffman's and Trömner's signs bilaterally, nystagmus, a sluggish right pupillary light reflex, and carotid bruit. Cervical radiographs were suggestive of Klippel-Feil syndrome. The chiropractor suspected a vascular cause such as a transient ischemic attack and referred the patient to the emergency department, which the patient visited the following day. The patient was admitted, and MRI revealed multiple tiny acute to subacute cortical infarcts of the left frontal and parietal lobes while sonography demonstrated left internal carotid artery stenosis. The patient was treated with anticoagulant and antiplatelet medications and carotid endarterectomy with a positive outcome. Given the overlap between symptoms of stroke and those of the cervical spine, chiropractors should be prepared to recognize potential stroke patients and refer them for emergent medical management.

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“…Kranenburg et al zeigten zudem, dass positive prämanipulative Tests nicht zwangsläufig auf eine Veränderung der Hämodynamik hinweisen 33 . Außerdem sollten selbst bei auftretenden neurologischen Zeichen und Symptomen nicht nur das Gefäßsystem, sondern auch andere Systeme, wie das zervikogene und vestibuläre System, für die Auslösung neurologischer Zeichen und Symptome in Betracht gezogen werden.…”

Section: Klinische Relevanzunclassified

“…Die zerebrale Blutver sorgung und die Konsistenz der Arterie sind also trotz des singulären Einflusses auf die Hämodynamik ausreichend vorhanden und schei nen nicht dafür verantwortlich zu sein, dass Schmerzen oder neurolo gische Zeichen und Symptome auftreten [30][31][32]. Kranenburg hinweisen [33]. Außerdem sollten selbst bei auftretenden neuro logischen Zeichen und Symptomen nicht nur das Gefäßsystem, sondern auch andere Systeme, wie das zervikogene und vestibulä re System, für die Auslösung neurologischer Zeichen und Sympto me in Betracht gezogen werden.…”

Section: Klinische Relevanzunclassified

“…Außerdem sollten selbst bei auftretenden neuro logischen Zeichen und Symptomen nicht nur das Gefäßsystem, sondern auch andere Systeme, wie das zervikogene und vestibulä re System, für die Auslösung neurologischer Zeichen und Sympto me in Betracht gezogen werden. Hämodynamische Veränderun gen in den zervikalen Gefäßen bei Kopfbewegungen sind natürlich möglich, da sich der Diameter des Blutgefäßes verändert, aber scheinen nicht auszureichen, um systematisch Adverse Events aus zulösen [33]. Die IFOMPT weist in ihrer Leitlinie darauf hin, dass weder die be schriebenen Risikofaktoren noch einzeln durchgeführte Tests im Screening ausreichen [34].…”

Section: Klinische Relevanzunclassified

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Haben endgradige Tests an der HWS einen Einfluss auf die Hämodynamik hirnzuführender und (intra-)kranieller Gefäße?

Moll

Piekartz

2023

MSK – Muskuloskelettale Physiotherapie

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ZusammenfassungPhysiotherapeut*innen werden häufig von Patient*innen mit Kopf- und Nackenbeschwerden konsultiert. Es besteht die Möglichkeit, dass sich hinter diesen Beschwerden vaskuläre Dysfunktionen verbergen. Die Herausforderung besteht daher, die geringe Zahl an Patient*innen ohne muskuloskelettale Ursache herauszufiltern und in die ärztliche Versorgung zu überweisen. Seit 2020 bietet die International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) eine aktualisierte Richtlinie für die Untersuchung und das Management von Patient*innen mit HWS-/Nackenbeschwerden, die potenziell ein vaskuläres Geschehen aufweisen. Dies soll Physiotherapeut*innen Sicherheit im Umgang mit diesen klinischen Fragestellungen geben und eine bestmögliche Entscheidung für das weitere Patientenmanagement ermöglichen.Der Artikel stellt, vor dem Hintergrund mehrerer aktueller Forschungsartikel zur mechanischen Belastung des vaskulären Systems der zervikokranialen Region, die grundlegenden klinischen Muster arterieller Dysfunktionen der HWS dar und gibt einen Einblick, wie diese Beschwerden differenzialdiagnostisch eingeordnet werden können. Anhand eines Fallbeispiels wird das Wissen in den klinischen Alltag übertragen.

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Effects of Head and Neck Positions on Blood Flow in the Vertebral, Internal Carotid, and Intracranial Arteries: A Systematic Review

Cited by 11 publications

References 53 publications

The Effects of Cervical Mobilization with Clinical Pilates Exercises on Pain, Muscle Stiffness and Head and Neck Blood Flow in Cervicogenic Headache: Randomized Controlled Trial

The Effects of Cervical Mobilization with Clinical Pilates Exercises on Pain, Muscle Stiffness and Head and Neck Blood Flow in Cervicogenic Headache: Randomized Controlled Trial

An Adult Patient With Acute Ischemic Stroke and Carotid Stenosis Presenting to a Chiropractor: A Case Report

Haben endgradige Tests an der HWS einen Einfluss auf die Hämodynamik hirnzuführender und (intra-)kranieller Gefäße?

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