Manipulation der HWS und Evidenzbasierte Medizin[1]

Zusammenfassung

Besonders die Manipulation an der HWS beinhaltet ein seltenes, aber doch dramatisches Risiko vor allem (zerebro-) vaskulärer Komplikationen. Anhand einer Literaturanalyse untersucht die vorliegende Arbeit die Merkmale der Manipulation im Hinblick auf diese Risiken. Die Arten und Häufigkeiten der Komplikationen werden beschrieben. Der Schwerpunkt liegt auf der vertebrobasilären Insuffizienz, für die prämanipulative Tests keine Hinweise liefern. Die Verlängerung der Arterie ebenso wie die hohe Geschwindigkeit der Bewegung als dazu führende Mechanismen werden diskutiert. Das größte Risiko scheinen Rotationsbewegungen zu bergen. Es fanden sich weder Studien, die gezielt die Risiken der für Physiotherapeuten empfohlenen geradlinigen translatorischen Manipulationen untersuchen, noch solche mit Wirkungsvorteilen der Manipulation gegenüber der Mobilisation. Das Risiko-Nutzen-Verhältnis der Manipulation sowie Empfehlungen zu ihrem Erlernen werden erörtert.

Abstract

Especially cervical spine manipulation involves a rare but still dramatical risk particularly of (cerebro-) vascular complications. By means of a literature analysis this article investigates the characteristics of manipulation in view of these risks. Types and frequencies of complications are described. The main focus lies on vertrebobasilar insufficiency which cannot be detected by premanipulative tests. Arterial elongation as well as the high velocity used are discussed as possible mechanisms for this. Rotation movements seem to be fraught with risks. No studies were found that specifically examine the risks of linear translatory manipulations as recommended for physiotherapists or that show beneficial effects of manipulation compared to mobilisation. Risk-benefit ratio of manipulation as well as recommendations for learning manipulation are reconsidered.

Manipulation - Rotation - Translation - Risiken - vertebrobasiläre Insuffizienz - Evidenz-basierte Medizin

manipulation - rotation - translation - risks - vertebrobasilar insufficiency - evidence based medicine

Literatur

• 1 Bayer K. „Weich” und „hart” bei der Manipulation, Überlegungen zur Beurteilung der Kräfte, die bei der Kopfgelenkmanipulation auftreten und darüber, wann eine Methode „weich” ist.  Manuelle Medizin. 1998;  36 296-299
• 2 Childs J D, Fritz J M, Piva S R. et al . Clinical decision making in the identification of patients likely to benefit from spinal manipulation: a traditional versus an evidence-based approach.  Journal of Orthopaedic & Sports Physical Therapy. 2003;  33 259-272
• 3 Childs J D, Flynn T W, Fritz J M. et al . Screening for vertebrobasilar insufficiency in patients with neck pain: manual therapy decision-making in the presence of uncertainty.  Journal of Orthopaedic & Sports Physical Therapy. 2005;  35 300-306
• 4 Cleland J A, Childs M JD, McRae M. et al . Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial.  Manual Therapy. 2005;  10 127-135
• 5 Chartered Society of Physiotherapy (CSP) . Guidance for the safe teaching of manipulation to clinical undergraduates.  2007;  , www.csp.org.uk
• 6 Descarreaux M, Dugas C, Lalanne K. et al . Learning spinal manipulation: the importance of augmented feedback relating to various kinetic parameters.  The Spine Journal. 2006;  6 138-145
• 7 Di Fabio R P. Manipulation of the cervical spine: risks and benefits.  Physical Therapy. 1999;  79 50-65
• 8 Enebo B, Sherwood D. Experience and Practice Organization in Learning a Simulated High-Velocity Low-Amplitude Task.  Journal of Manipulative and Physiological Therapeutics. 2005;  28 33-43
• 9 Ernst E. Prospective investigations into the safety of spinal manipulation.  Journal of Pain and Symptom Management. 2001;  21 238-242
• 10 Ernst E. Manipulation of the cervical spine: a systematic review of case reports of serious adverse events 1995 - 2001.  MJA. 2002;  176 376-380
• 11 Ernst E, Canter P H. A systematic review of systematic reviews of spinal manipulation.  Journal of the Royal Society of Medicine. 2006;  99 192-196
• 12 Evan D W. Mechanisms and effects of spinal high-velocity, low-amplitude thrust manipulation: previous theories.  Journal of Manipulative and Physiological Therapeutics. 2002;  25 251-262
• 13 Flynn T W, Wainner R S, Fritz J M. Spinal manipulation in physical therapist professional degree education: a model for teaching and integration into clincal practice.  Journal of Orthopaedic & Sports Physical Therapy. 2006;  36 577-587
• 14 Gibbons P, Tehan P. Patient positioning and spinal locking for lumbar spine rotation manipulation.  Manual Therapy. 2001;  6 130-138
• 15 Good C. Internal forces sustained by the vertebral artery during spinal manipulative therapy. Letter to the editor.  Journal of Manipulative and Physiological Therapeutics. 2003;  26 338-340
• 16 Graf-Baumann T. Zur Zulässigkeit von Manipulationen an der Wirbelsäule durch Physiotherapeuten.  Krankengymnastik. 1997;  49 1157-1167
• 17 Gross A R, Kay T, Hondras M. et al . Manual therapy for mechanical neck disorders: a systematic review.  Manual Therapy. 2002;  7 131-149
• 18 Gross A R, Kay T M, Kennedy C. et al . Clinical practice guideline on the use of manipulation or mobilization in the treatment of adults with mechanical neck disorders.  Manual Therapy. 2002;  7 193-205
• 19 Gross A R, Hoving J L, Haines T A. Cervical Overview Group . A Cochrane review for manipulation and mobilization for mechanical neck disorders.  Spine. 2004;  9 1541-1548
• 20 Guideline Development Committee, The CCA/CFCRB-CPG . Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash.  Journal of Canadian Chiropractor Association. 2005;  49 158-209
• 21 Haas M, Groupp E, Panzer D. et al . Efficacy of cervical endplay assessment as an indicator for spinal manipulation.  Spine. 2003;  28 1091-1096
• 22 Haldeman S, Kohlbeck F J, McGregor M. Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation.  Spine. 1999;  24 785-794
• 23 Haldeman S, Carey P, Townsend M. et al . Clinical perception of the risk of vertebral artery dissection after cervical manipulation: the effect of referral bias.  The Spine Journal. 2002;  2 334-342
• 24 Haldeman S, Kohlbeck F J, McGregor M. Stroke, cerebral artery dissection, and cervical spine manipulation therapy.  Journal of Neurology. 2002;  249 1098-1104
• 25 Haldeman S, Kohlbeck F J, McGregor M. Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy, a review of sixty-four cases after cervical spine manipulation.  Spine. 2002;  27 49-55
• 26 Haynes M J. Vertebral arteries and cervical movement: doppler ultrasound velocimetry for screening before manipulation.  Journal of Manipulative and Physiological Therapeutics. 2002;  25 556-567
• 27 Haynes M. Internal forces sustained by the vertebral artery during spinal manipulative therapy. Letter to the editor.  Journal of Manipulative and Physiological Therapeutics. 2004;  27 67-68
• 28 Hollmann W. Training, Grundlagen und Anpassungsprozesse. Schorndorf; Hofmann 1990
• 29 Hondras M A, Long C R, Brennan P C. Spinal manipulative therapy versus a low force mimic manoeuver for women with primary dysmenorrhea: a randomized, observer-blinded, clinical trial.  Pain. 1999;  81 105-114
• 30 Hurwitz E L, Aker P D, Adams A H. et al . Manipulation and mobilization of the cervical spine. A systematic review of the literature.  Spine. 1996;  21 1746-1760
• 31 Inamasu J, Guiot B H. Iatrogenic vertebral artery injury.  Acta Neurologica Scandinavica. 2005;  112 349-357
• 32 Jacobi G, Riepert T, Kieslich M. et al . Todesfall während der Physiotherapie nach Vojta.  Zeitschrift für Physiotherapeuten. 2001;  53 573-576
• 33 Jull G, Magarey M, Niere K. et al . Physiotherapy, a responsible profession to use cervical manipulation. Response to Refshauge et al.  Australian Journal of Physiotherapy. 2002;  48 180-183
• 34 Jull G. Use of high and low velocity cervical manipulative therapy procedures by Australian manipulative physiotherapists.  Australian Journal of Physiotherapy. 2002;  48 189-193
• 35 Kaltenborn F M. Manuelle Therapie nach Kaltenborn, Untersuchung und Mobilisation der Gelenke. Teil I: Extremitäten Oslo; Norli 2005
• 36 Kaltenborn F M. Manuelle Therapie nach Kaltenborn, Untersuchung und Mobilisation der Gelenke. Teil II: Wirbelsäule Oslo; Norli 2004
• 37 Kaltenborn F M. Persönliche Mitteilung.  2007; 
• 38 Kaltenborn F M. Traction manipulation of the extremties and spine. 2007 (in press)
• 39 Kerry R, Taylor A, Mitchel J. et al . Cervical artery insufficiency and manipulative therapy, a literature review.  Manipulation Association of Chartered Physiotherapists. 2005;  2 1-19
• 40 Kohlbeck F J, Haldeman S. Medication-assisted spinal manipulation.  The Spine Journal. 2002;  2 288-302
• 41 Licht P B, Christensen H W, Svendsen P. et al . Vertebral artery flow and cervical manipulation: an experimental study.  Journal of Manipulative and Physiological Therapeutics. 1999;  22 431-435
• 42 Magarey M E, Rebbeck T, Coughlan B. et al . Pre-manipulative testing of the cervical spine. Review, revision and new clinical guidelines.  Manual Therapy. 2004;  9 95-108
• 43 Malone D G, Baldwinn N G, Tomecek F J. et al . Complications of cervical spine manipulation therapy: 5-year retrospective study in a single-group practice.  Neurosurg Focus. 2002;  13 1-8
• 44 Mann T, Refshauge K M. Causes of complications from cervical spine manipulation.  Australian Journal of Physiotherapy. 2001;  47 255-266
• 45 Martínez-Segura R, Fernández-de-las-Peñas, Ruiz-Sáez M. et al . Immediate effects on neck pain and active range of motion after a single cervical high-velocity low-amplitude manipulation in subjects presenting with mechanical neck pain: a randomized controlled trial.  Journal of Manipulative and Physiolocigal Therapeutics. 2006;  29 511-517
• 46 Melzack R, Wall P D. The challenge of pain. Harmondsworth; Penguin 1996
• 47 Oppenheim J S, Spitzer D E, Segal D H. Nonvascular complications following spinal manipulation.  The Spine Journal. 2005;  5 660-667
• 48 Panjabi M M, White A A. Biomechanics in the musculoskeletal system. New York; Churchill Livingstone 2001
• 49 Pickar J G, Kang Y M. Paraspinal muscle spindle responses to the duration of a spinal manipulation under force control.  Journal of Manipulative and Physiological Therapeutics. 2006;  29 22-31
• 50 Refshauge K M, Parry S, Shirley D. et al . Professional responsibility in relation to cervical spine manipulation.  Australian Journal of Physiotherapy. 2002;  48 171-179
• 51 Rivett D A, Sharples K J, Milburn P D. Effect of premanipulative tests on vertebral artery and internal carotid artery blood flow: a pilot study.  Journal of Manipulative and Physiological Therapeutics. 1999;  22 368-275
• 52 Rivet D, Shirley D, Magarey M. et al . Clinical guidelines for assessing vertebro-basilar insufficiency in the management of cervical spine disorders.  Australian Journal of Physiotherapy. 2006;  , www.physiotherapy.asn.au
• 53 Rosner A L. Zerebrovaskuläre Ereignisse, Risiken der zervikalen Manipulationsbehandlung im Licht neuerer Erkenntnisse - ein Überblick.  Manuelle Medizin. 2003;  41 215-223
• 54 Schöttker-Königer T. Leserbrief zu: Schomacher J. Falsch positiver Stabilitätstest der Ligg. alaria.  Manuelle Therapie. 2001;  5 24-27
• 55 Schomacher J. Falsch positiver Stabilitätstest der Ligg. alaria.  Manuelle Therapie. 2000;  4 127-132
• 56 Schulze F, Müller W, Wassermeyer D. Stellungnahme zum Beitrag „Todesfall während der Physiotherapie nach Vojta” im Heft Nr.4 / 2001.  Zeitschrift für Physiotherapeuten. 2001;  53 944
• 57 Smith W S, Johnston S C, Skalabrin E J. et al . Spinal manipulative therapy is an independent risk factor for vertebral artery dissection.  Neurology. 2003;  60 1424-1428
• 58 Stevinson C, Honan W, Cooke B. et al . Neurological complications of cervical spine manipulation.  Journal of the Royal Society of Medicine. 2001;  94 107-110
• 59 Symons B P, Leonard T, Herzog W. Internal forces sustained by the VA during SMT.  Journal of Manipulative and Physiological Therapeutics. 2002;  25 504-510
• 60 Triano J J, Rogers C M, Coms S. et al . Developing Skilled Performance of Lumbar Spine Manipulation.  Journal of Manupulative and Physiological Therapeutics. 2002;  25 353-361
• 61 Triano J J, Rogers C M, Combs S. et al . Quantitative feedback versus standard training for cervical and thoracic manipulation.  Journal of Manipulative and Physiological Therapeutics. 2003;  26 131-139
• 62 Waddell G. The Back pain revolution. Edinburgh; Churchill Livingstone 1998
• 63 Westerhuis P, Rivet D. et al . Clinical Guidelines for Assessing Vertebrobasilar Insufficiency in the Management of Cervical Spine Disorders.  manuelletherapie. 2006;  10 240-242
• 64 Wolf U, Wilke A, Kaltenborn F M. et al . Komplikationen bei Manipulation der Wirbelsäule durch Physiotherapeuten.  Krankengymnastik. 1996;  48 1203-1208
• 65 Wolf U. Qualitätssicherung durch Fortbildungspunkte? Editorial.  physioscience. 2006;  2 89-90
• 66 Wood T, Colloca C J, Matthews R. A pilot randomised clinical trial on the relative effect of instrumental (MFMA) versus manual (HVLA) manipulation in the treatment of cervical spine dysfunction.  Journal of Manipulative and Physiological Therapeutics. 2001;  24 260-271
• 67 , www.ifomt.org (26.9.2006)

1 Die vorliegende Arbeit wurde ohne finanzielle Unterstützung, den Auftrag einer Vereinigung oder Institution in Eigeninitiative erstellt.