A framework published by the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) has concluded the best practice for the assessment of patients with head and neck pain. The framework, International Framework for Examination of the Cervical Region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy Intervention, which took five years to compile and has been reviewed in twenty-two countries, analyses the correct use of evidence-based interventions, such as manipulation, which has been associated with stroke and vertebral artery dissociation amongst other pathologies.
This framework provides guidance for the assessment of the cervical spine region for the potential of Cervical Artery Dysfunction (CAD) before any manipulative therapy is applied. The document defines CAD as rare but stresses that it should be considered nonetheless. Other key guidance points include not to rely on the results of only one test to draw conclusions, therefore it is imperative to understand the patient’s presentation after an informed, planned and individualised assessment. Physiotherapist’s should aim to make the best judgement on the probability of serious pathology and contraindications to treatment based on information from the patient history. Key considerations are also included for the physiotherapist during the selection and application of cervical manipulation as a treatment intervention. This document also provides guidance on alternative approaches to direct cervical treatment, frequency of treatment, minimising end-range cervical techniques, force minimisation, and monitoring for adverse effects.
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