Unease about c-spine manipulation

[RNtoMD87]

Will this cause me trouble if I go to a DO school? The risk of carotid artery dissection makes me nervous. Not a huge fan of chiropractics.

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[HoosierDoc1]

Alright let's see if we can clear some of this up. First off, no you won't be in trouble if you go to a DO school Many people have the same fears as you when it comes to HVLA of the cervical spine. For this reason, many schools do not specifically test you over it. I can only speak for the school I attend (MUCOM) but we were told that we could be tested on how to set it up, but would never be asked to deliver the final thrust. You should also be aware that the risk of stroke, or like-wise is low in the "average" patient. That being said, there are absolutely scenarios where you cannot use this technique at all--patients with carotid stenosis, osteoporosis, etc.

But you should also know that there are MANY ways to manipulate and treat the cervical spine WITHOUT HVLA.

As an OMS-II, I can say that only a handful of people in my class can actually do HVLA on the neck, and we are the ones who took the time to learn it properly. If you aren't comfortable doing it, there are ways to get comfortable with it. I, personally, think it's worth learning because many patients actually do like, but to each their own.

 

[RNtoMD87]

Thanks for the response! Very helpful

 

[AnatomyGrey12]

No you won't get in trouble. I just go through the motions, I won't let anyone thrust on my neck.

 

[Angus Avagadro]

Will this cause me trouble if I go to a DO school? The risk of carotid artery dissection makes me nervous. Not a huge fan of chiropractics.

As stated above, there are contraindications to HVLA, like any modality. One of my med school classmates was doing PM&R residency and received a stroke patient from chiropractor who dissected pts vertebral artery. Pt was in her 70s. Never should have had HVLA performed on her as a post menopausal woman with cervical osteophytes. Plenty of options if you dont want to perform HVLA.

 

[RNtoMD87]

After keeping an open mind, but speaking to many physicians I question spinal manipulation. Jury isn't out for me, but I fail to see the difference between it and many other "alternative therapies" such as cupping, acupuncture, etc and the complications are worrisome for me.

 

[Angus Avagadro]

After keeping an open mind, but speaking to many physicians I question spinal manipulation. Jury isn't out for me, but I fail to see the difference between it and many other "alternative therapies" such as cupping, acupuncture, etc and the complications are worrisome for me.

Like anything, accuracy of diagnosis is key. I think HVLA has a place, but other modalities are easier to perform, and more comfortable for the patient. People get funny about have their c spine manipulated, and I get it. If done correctly, the risks are very small. It's a matter of how skillful the practitioner is

 

[Knight in shining armor]

When we learned it, we always had a professor check our diagnosis before we were allowed to do HVLA on someone’s neck. If our partner didn’t need it, we just set it up and told our trainer what we would do. However, I have actually done it to classmates and have had classmates do it to me. As an osteopathic physician, you do some things similar to ciropractors but it’s not exactly the same. With cervical HVLA, we really localize the issue which makes the procedure safe.

 

[Grannywang]

Cervical is probably the best part of OMM lol. I got to crack all the necks and having it done on you feels amazing. Even if your partner sucks at it, it won’t harm you. If they don’t get a good lock out and thrust, your paraspinals tend to tense up. Don’t be that student that whines about HVLA because no one has ever died in med school from it otherwise it wouldn’t be taught.

 

[Doc_Ock]

In our school were specifically told not to do an HVLA if we don’t sense any restriction. Since most of us don’t have it we don’t do it.


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[Angus Avagadro]

In our school were specifically told not to do an HVLA if we don’t sense any restriction. Since most of us don’t have it we don’t do it.


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Untrue. Most med students have a problem at C2 or C3. Check again.

 

[HoosierDoc1]

Untrue. Most med students have a problem at C2 or C3. Check again.

I mean, they aren’t wrong... you don’t thrust if there isn’t a restriction. It just happens that MANY people have restrictions.

 

[Deecee2DO]

Like anything, accuracy of diagnosis is key. I think HVLA has a place, but other modalities are easier to perform, and more comfortable for the patient. People get funny about have their c spine manipulated, and I get it. If done correctly, the risks are very small. It's a matter of how skillful the practitioner is

Current med student (DO) and former chiropractor here. Very very well said @Angus Avagadro . Also knowing WHEN it is okay to manipulate is important. A lot of chiropractors get blamed for vertebral artery dissections because they are negligent and didn't pick up on glaring or subtle signs of VBAI or impending stroke that should have been referred out. Also, knowing which type of patients should NOT get upper C/S HVLA like a female with EDS on contraceptives/smoker, any patients with RA, SLE, Downs patients that could have transverse ligament compromise. There are way more but still you can't just wail on everyone. Generating enough torque or force to actually initiate or cause a vertebral artery dissection from HVLA alone without any underlying pathology present is quite uncommon. Regardless, hyperextension of the C/S during C/S HVLA should never be performed

 

[Deecee2DO]

I mean, they aren’t wrong... you don’t thrust if there isn’t a restriction. It just happens that MANY people have restrictions.

@latinclubimperatus Although anecdotally, my best educated guess would say 9/10 med students have upper crossed syndrome with upper and/or lower C/S restrictions from the amount of "desk sitting" going on the first two years

 

[Medic741]

Will this cause me trouble if I go to a DO school? The risk of carotid artery dissection makes me nervous. Not a huge fan of chiropractics.

Have been very happy that our class takes this with a lot of caution too, and are respectful if you say that you aren't comfortable with XYZ being performed on you

 

[AlbinoHawk DO]

Yes, this will affect you if you go to a school like mine. Unless you have a medical condition, it will be expected that others will do HVLA on you. If you're in a practical exam, you will fail the class if you refuse to do it. HVLA is considered safe by the standards of the osteopathic profession, so as a student, you must do it because you have to show competency to be able to hold the degree.

 

[MotherofDragonflies]

For the DO students in here, would I be penalized if I flat out refuse to allow manipulation to be performed on me. Set up and getting up to the go-point I feel okay with. I get the impression it’s going to vary by school.

 

[AnatomyGrey12]

For the DO students in here, would I be penalized if I flat out refuse to allow manipulation to be performed on me. Set up and getting up to the go-point I feel okay with. I get the impression it’s going to vary by school.

Just say you have had a prior neck surgery. Yeah there would probably be issues if you flat out refused but you can get around that pretty easily.

 

[MotherofDragonflies]

Just say you have had a prior neck surgery. Yeah there would probably be issues if you flat out refused but you can get around that pretty easily.

I do actually have osteoarthritis...

 

[AnatomyGrey12]

I do actually have osteoarthritis...

There ya go, automatic disqualification lol. Just make sure you put that on the consent sheet you have to sign before doing HVLA.

 

[Doc_Ock]

For the DO students in here, would I be penalized if I flat out refuse to allow manipulation to be performed on me. Set up and getting up to the go-point I feel okay with. I get the impression it’s going to vary by school.

At my school no one would bat an eye.


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[Deecee2DO]

I do actually have osteoarthritis...

Probably not a good enough excuse haha Id go with surgery excuse. The majority of your patients someday who would be receiving HVLA from you have OA if you even decide to use it (most DOs wont). More people have OA than you think its extraordinarily common just a matter of degree. RA and other types of arthritides is a different story