International Framework for Examination of the Cervical Region for Potential of Vascular Pathologies of the Neck Prior to Musculoskeletal Intervention: International IFOMPT Cervical Framework

Abstract

SYNOPSIS: This position statement, stemming from the International IFOMPT (International Federation of Orthopaedic Manipulative Physical Therapists) Cervical Framework, was developed based upon the best contemporary evidence and expert opinion to assist clinicians during their clinical reasoning process when considering presentations involving the head and neck. Developed through rigorous consensus methods, the International IFOMPT Cervical Framework guides assessment of the cervical spine region for potential vascular pathologies of the neck in advance of planned interventions. Within the cervical spine, events and presentations of vascular pathologies of the neck are rare but are an important consideration as part of patient examination. Vascular pathologies may be recognizable if the appropriate questions are asked during the patient history–taking process, if interpretation of elicited data enables recognition of this potential, and if the physical examination can be adapted to explore any potential vasculogenic hypothesis. J Orthop Sports Phys Ther 2023;53(1):7–22. Epub: 14 September 2022. doi:10.2519/jospt.2022.11147

Clinical and Psychological Variables in Female Patients with Cervical Syndromes: A Cross-Sectional and Correlational Study

“…Perhaps, for this reason, no between-group differences were found. This is one of the reasons why cervical ROM is not clinically used as a diagnostic criterion [ 5 , 45 , 46 ].…”

Translating the new International IFOMPT Cervical Framework into a framework flowchart for clinical practice and education

“… Subtle signs and symptoms may require additional testing to support or refute the vascular hypothesis. Existing data support the use of conventional vascular examination [ 3 ] whereby the following tests are recommended [ 2 ]: blood pressure, cranial nerve examination and gait pattern. Having a high index of suspicion of vascular pathology may justify referral for further investigation.…”

“…The first step is to recognize signs and symptoms of severe (vascular) pathology during the patient interview. In this case description, the sudden onset, high initial pain intensity (headache and neck pain), the restricted cervical rotation movement, nausea, ipsilateral headache, smoking history, hypertension, comorbid diabetes mellitus are signs and symptoms of the patient’s history that can be linked to potential vascular pathologies of the neck [ 2 , 5 ].…”

“…In 2020, a revised version of the International IFOMPT Cervical Framework was published to guide the assessment of the cervical spine region for potential vascular pathologies of the neck in advance of planned Orthopaedic Manual Therapy (OMT) interventions as used by OMT certified physical therapists [ 2 ]. The aim of the framework is to provide both physical therapists and educators the necessary information to teach and practice the examination of the cervical spine.…”

Ten years of online incident reporting and learning using CPiRLS: implications for improved patient safety.

“…Chiropractors reporting SIs often re ected on the importance of case history taking when, in retrospect, the patient was shown to be presenting with serious underlying pathology. To enhance patient safety, patients should always be screened for masqueraders of musculoskeletal pain (including vascular pathologies of the neck) through appropriate case history taking and physical examination [42]. Consideration should also be given to continuity of care during the management of patients.…”