needed to assess the safety of cervical spine SMT with regards to cerebrovascular events. Such studies should also account for the education of the practitioner”. “Changes in vertebral artery blood flow following various head positions and cervical spine manipulations”, JMPT 37(1) 22-31 Quesnele et al. Findings: “The side to side differences between ipsilateral and contralateral Vertebral artery velocities was not significant for either velocities or flows throughout the conditions.” Conclusion: “There were no significant changes in blood flow or velocity in the Vertebral arteries of health male adults after various head positions or cervical spine manipulation” In a neutral head position physiologic measures of blood flow and velocity at the C1-C2 spinal level were obtained using phase contrast MRI after three different head positions and after an upper cervical manipulation. Thirty (30) flow encoded phase contrast images were collected over the cardiac cycle. Differences in flow and velocity were repeatedly analyzed. These analyses did not reveal any meaningful changes in blood flow or velocity that would predispose a patient to injury to the vertebral arteries or that would create an environment more likely to generate a thrombotic event. 1. Patients with a personal or family history of collagen disorders such as Marfan’s Disease, Ehler- Danlos Syndrome etc 2. Patients who present describing a headache or neck pain as the “most unusual pain in their head (or neck) that they ever had” 3. Patients with any of the 5 Ds (dizziness, diplopia, drop attacks, dysarthria, dysphagia), the 3 Ns (nausea, numbness, nystagmus) or an A (ataxia) [Patients often present for chiropractic care with numbness or dizziness, these are not necessarily contraindications but may be when other neurological symptoms are present] 4. Patients that demonstrate a worsening of any of the 5Ds, the 3 Ns or the A after an adjustment 5. Patients that develop new symptoms, particularly related to Cranial Nerve dysfunction, sensory disturbances or motor function, following an adjustment. Time is of the essence for a patient experiencing an arterial dissection and/or stroke. It is urgent that you seek emergency medical services for a patient who complicates as noted above. Every person involved in health care, regardless of the discipline or clinical approach, wants each patient to be healthier and happier as a result of the care provided to them. We, like all other providers need to be attentive to the presentation of our patients and to consider those circumstances that call for caution in providing care, withholding care or referring that patient for additional evaluation and consultation before delivering care. Because there are so few adverse effects of chiropractic care and because we are not called upon to deal routinely with the complications of care other disciplines it is easier to be less attuned to areas of concern—this is something we must not allow ourselves to do. Signs and Symptoms to be Alert To
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