Masterclass pre-treatment clinical reasoning and examination of the cervical spine

Course Description
Manipulation and mobilization of the cervical spine are well-established interventions in the management of patients with headache and/or neck pain. However, their benefits are accompanied by potential, yet rare risks in terms of serious adverse events. Therefore, prior to cervical spine manual therapy, a risk-benefit analysis should be performed in which the potential risks for vascular pathologies and (vascular) complications after manipulation should be weighed against the potential benefits. This risk should be estimated for each patient, based on all current factors surrounding the particular situation at that particular time.

In their clinical reasoning, manual therapists must rely on information based on the patient interview and physical examination with regard to clinical signs and symptoms and available risk factors for the different diseases/disorders and interpret this information carefully. There are three important steps in the clinical reasoning process: 1) identifying a possible vasculogenic contribution or other serious pathology; 2) determining whether there is an indication or contraindication for mobilization or manipulation; and 3) assessing the presence of any potential risk factors associated with potential serious adverse events which are reported to occur after cervical spine mobilization and/or manipulation.

This course will start with a general introduction on vascular pathologies and injuries, which present as neuromusculoskeletal dysfunction. After this thorough introduction, this course will focus on the knowledge and skills necessary for the assessment of patients with head and neck pain and their risk of adverse events. We will focus on the mentioned three important steps in the clinical reasoning process. In this part, the benefits of treatment, indications for cervical spine manipulation, risks of cervical spine manipulation, anatomy of the upper cervical spine region, potential risk factors, and contraindications will be discussed. Moreover, practical guidelines for patient interview and physical examination (including screening tests, blood pressure assessment and cranial nerve examination) will be provided.

Learning objective: Upon completing this course, participants will have extensive knowledge about (identifying) vascular pathologies in the cervical spine region which present as neuromusculoskeletal dysfunction and about indications, contraindications and risk factors for cervical spine manual therapy. Participants will be able to conduct an evidence based clinical reasoning process and examination (focused on the recognition of a vascular contribution and prevention of [vascular] complications) before applying manual therapy treatment to the cervical spine.

Dr. Nathan Hutting is currently working as a physical therapist and manual therapist in a private practice and as a researcher at the HAN University of Applied Sciences, research group Occupation & Health,Netherlands. His current research topics include self-management, (work related) musculoskeletal disorders, pre-manipulative screening procedures and healthy living. He is also a board member of the Dutch Association for Manual Therapy (NVMT) and Member Organisation delegate of the Netherlands in the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT).