Can the risk of Vertebral Artery Dissection be determined with pre-manipulative screening?

Cervical manipulation has inherent risks. One of the the most dangerous adverse effects following cervical manipulation is vertebral artery dissection (VAD). For the past two decades, functional pre-manipulative screening tests have been used by Physiotherapists to identify patients at risk of vertebral artery insufficiency (VBI). Many experts in the field of VAD and cervical manipulation have started to question the clinical validity of these tests and currently there is great uncertainty if the tests themselves are potentially dangerous enough to cause VAD. 

This blog aims to review the risk of cervical manipulation, the clinical presentation of VBI and the current assessment recommended by the Australian Physiotherapy Association. I'm also pleased to include the thoughts and recommendations of Dr. Mark Percy, Specialist Radiologist from MIA Lilydale, Victoria. 

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Defining Clinical pilates exercises and its indications for treatment

Wells and colleagues published two articles in 2013 and 2014 which have caught my attention. Both use a delphi study method (with Australian Physiotherapists with pilates training through DMA or Polestar) to develop consensus about the definition and application of pilates exercise and the indications, benefits and risks of this approach. This blog explores each area in further depth. 

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