Rightly or wrongly, manipulation and mobilization of the spine remain an essential part of physiotherapeutic treatment. There are numerous complications from using this treatment and abnormal heart function, and blood pressure is one of them. A systematic review published in the Hong Kong Journal of Physiotherapy aimed to clarify whether or not manual therapy affects heart function and, in particular, blood pressure.
Cervical arterial dysfunction | Roger Kerry
Methodology
PRISMA was the guideline used and the review was registered in PROSPERO. Both are signs of a solid systematic review. The Cochrane Library and PubMed were the databases of choice for the search strategy. It would have been ideal to see another one or two, but these are likely the bare minimum. Search was limited to RCTS, English language, and decent keywords using MeSH and Boolean terms and operators. Three reviewers were included, which is standard in the systematic review method. Articles were included if they assessed at least one heart parameter.
The risk of bias and PEDRo was used to assess the methodological quality of each study included in the review. After implementing the search strategy, 11 studies were included in the meta-analysis.
Results and clinical implications
It is frustrating that no raw blood pressure records can be seen in the publication, which makes it difficult to criticize the results. The article reports that there was a statistically significant decrease in systolic blood pressure when the results of the studies were pooled. The diastolic blood pressure had no statistically significant decrease in pressure and the same is true for the heart rate. The physiological lowering of blood pressure can be attributed to the effect on the autonomic nervous system. Or maybe it's just because the patient is relaxed, who knows, because the numbers aren't published.
If a patient has low systolic blood pressure prior to performing the manipulation, precautions must be taken to ensure that they do not have a vasovagal episode during or after the procedure. Better still, if an alternative treatment option is found first. What the review doesn't say is what speed, location, or type of manipulation or mobilization is causing the drop in blood pressure, only that there is a risk of the drop.
Oddly enough, the paper suggests that mobilization or manipulation can be used as an additional treatment for high blood pressure. This is frankly a ridiculous statement and should not be used as a justification for using this treatment. Ever.
Does this systematic review confirm the extensive research and clinical practice of international expert Roger Kerry? Why not take his Cervical Artierial Dysfunction (CAD) course to find out?
Make a safe clinical decision with Roger Kerry
Cervical arterial dysfunction (CAD) is used in physiotherapy to cover a variety of vascular pathologies that can restrict blood flow to the brain. When evaluating and treating the cervical spine, it is important to understand blood vessel disorders that can be associated with pain and to assess the risk of a patient experiencing restriction in arterial flow during a physiotherapy evaluation or treatment. In this course, you will learn from a subject specialist how to make confident clinical decisions that address these very serious issues and how to update the appropriate framework for clinical practice.
Cervical arterial dysfunction | Roger Kerry
