The MACP and Society of Orthopaedic Medicine have just come out with a new
set of guidelines for testing. You can probably find this information
through either organisation.

Kevin is right that there is the suggestion that the test can be provocative
and some authors suggest no forced movements/end of range activity for 4-6
weeks post automobile accident. Kevin is also correct that it is really
important to perform ligament testing first as if there is a problem you
will hurt the patient before you get to the VBI test.

I would differ though as to whether the upper neck is the only source of VBI
symptoms and it would not be prudent to assume that by avoiding the upper
neck that there is no chance of injuring the patient with other neck
exercises or techniques. Other sites that might be important ...

1. anomilies of the origin of the subclavian artery may allow for more
kninking in the artery early in its course up the neck(Kojima et al 1985)
2. the deep bands of the cervical fascia can be restrictive (Hardin et al
1963)
3. the artery can be caught between interdigitations of longus colli and
scalenus anterior at the C6 transvers process on ipsilateral rotation (Husni
et al 1963)
4. the artery and its accompanying venous and nerve plexus can be subject to
compression or irritation by uncovertebral joint osteophytes...commonly C5-6
but also at C4-5 and C6-7(Bogduk,1986)
etc etc etc..........

Oostendorp presented a paper at IFOMT in Oxford in 1988.  He discussed that
there were mechanical, chemical and neurological components that could lead
to arterio-spasm of the vertebral artery.   He discusses spasmogenesis and
suggests that trophic disturbances affecting the lining of the blood vessel
may well leave the patient at risk.   The theory is that the damage to the
tunica intima may not be obvious until it is damaged further.  This is the
sort of thinking taught in
the Canadian Manual Therapy System and by the North America Institue of
Orthopaedic Manipulative Therapy.  It might be to prevent problems with
lawsuits for other reasons.  Who knows.  But...since there is evidence that
a traumatized vessel may be more likely to be damaged by
examination/treatment in the first four weeks it might be something to
consider.

But...when  you are going to treat then it would seem judicious to do
pre-treatment testing of the whole length of the neck(the exact method is a
matter of opinion).

Cheers, Ross


----- Original Message -----
From: kevin reese <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, March 24, 2000 10:34 AM
Subject: Re: VBI testing


> Dear Jane
>
> I once heard of a paper, but have never seen it, suggesting there are as
> many serious incidents due to VBI testing as in high velocity thrust
> manipulation.
>
> As I due not favour grade Vs to this region I do not see much merit in VBI
> testing. If someone has a serious circulatory deficiency why stress it and
> then say, 'better not do that again'. If I were to do a pre grade V exam
the
> upper cervical instability tests seem more sensible.
>
> If the treatment is done with feedback and sensitivity and generally
thrust
> and combined movements are avoided, why test at all?.
>
> Warm Regards Kevin Reese  UK PT
> -----Original Message-----
> From: jane miller <[log in to unmask]>
> To: [log in to unmask] <[log in to unmask]>
> Date: 24 March 2000 14:17
> Subject: VBI testing
>
>
> >dear all
> >our department is interested to know the variations in the testing of
> >vertebral artery insufficiency. Are there any definitive guidelines for
> >testing?
> >jane Miller
> >______________________________________________________
> >Get Your Private, Free Email at http://www.hotmail.com
> >
> >
>




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