5 Signs and Symptoms You Should Avoid Cervical Manipulation

Neck pain can limit your ability to work or concentrate.
Cervical manipulation may be a dangerous treatment for your neck pain. Eric Audras/Getty Images

If you have neck pain or cervical radiculopathy, then you understand how this condition can affect your life.  Neck pain can make sitting, standing or turning your head so painful that it may be difficult to work, relax, or enjoy your normal activities.  Cervical radiculopathy, or pain in your arm coming from your neck, may cause weakness in your arm or hand and may make using your arm difficult or impossible.

Physical therapy can be an effective treatment for neck pain.  Your physical therapist may use various treatment techniques to decrease your pain.  He or she may prescribe specific neck exercises to help improve your mobility.  Your PT will also teach you to maintain proper posture to help prevent future episodes of neck pain.

Occasionally physical modalities like electrical stimulation or ultrasound may be used to help treat your neck pain.  Cervical traction may be applied to decrease pressure on the discs and joints in your neck.  Caution should be used with these treatments; passive modalities like these should only be used sparingly and do not take the place of active exercise and treatments.

Your physical therapist may also treat your neck pain with hands-on manual techniques.  These techniques, called cervical joint mobilizations or manipulations, are intended to rapidly improve your neck motion and augment your active neck exercises.

 Cervical mobilizations require specialized training, and your physical therapist should proceed cautiously when using neck mobilizations and manipulations.

Can cervical manipulation be dangerous to your health?  Perhaps.

What Can Go Wrong?

Your neck contains bones, discs, joints, and muscles.  There are also nerves, tendons, veins, and arteries.

 One particular artery, the vertebrobasilar artery, travels in close proximity to your neck bones.  There is one vertebral artery on each side of your neck, and these arteries travel through your neck and into a specific area of your brain.

Any injury to your vertebrobasilar artery can cause an immediate stroke, as the blood supply to areas of your brain the artery serves will become compromised.  A condition known as vertebrobasilar insufficiency (VBI) may mean you have a weakened vertebrobasilar artery, and a forceful manipulation to your neck may dissect or disrupt this artery and lead to a stroke.  Although a stroke caused by a cervical manipulation is a rare occasion, it can happen.

Warning Signs of VBI and Possible Danger to Cervical Manipulation

There are specific signs and symptoms that indicate you may have VBI and should avoid neck mobilization and manipulation.  If you have any of these symptoms along with your neck pain, inform your physical therapist (or other healthcare professional) before allowing any cervical mobilization procedure to be performed on you.

You may have only one of the following symptoms, known as the 5 "D's" of Coman.  Still, any symptom listed below should be discussed with your PT and doctor if you have neck pain.

The 5 "D's" of Coman are:

  1. Dizziness. If you are experiencing vertigo or dizziness, it may simply be a symptom of BPPV or vestibular system compromise.  Dizziness may also be a sign of VBI, and when accompanied by neck pain, serious consideration should be given about the safety of performing neck manipulation.
  2. Dysphagia.  Dysphagia is the clinical term for swallowing dysfunction.  If you are having difficulty swallowing food, then your PT or doctor may suspect VBI.  In this case, neck manipulation should be avoided.
  3. Dysarthria.  Dysarthria is difficulty forming words with the muscles of your mouth.  If you are having difficulty speaking properly, it may be a sign of VBI, and cervical mobilization should be avoided.  Of course, if you are experiencing dysarthria, a visit to your doctor is necessary.
  4. Drop Attack.  If you are suddenly experiencing attacks of passing out for no apparent reason, you vertebrobasilar artery may be compromised, and you should visit your doctor right away.  Cervical manipulation should be avoided if you are having such symptoms.
  5. Diplopia.  Diplopia means double vision.  If you are having any vision changes such as double vision, you may have VBI and cervical mobilization or manipulation may be dangerous for you.  A visit to your doctor is in order if you are experiencing diplopia.

During your initial assessment with your physical therapist, you will be asked a lot of questions about your current condition and past medical history.  Your PT should ask you specific questions about the 5 "D's" of Coman to assess whether cervical mobilization and manipulation are appropriate treatments for you.  Any of the signs and symptoms are a signal that manipulation to your neck may put you at risk for a stroke.

Remember that cervical mobilization can be an effective and useful strategy to help improve your neck range of motion.  It should only be used to augment your active neck exercise program.  It should not be the only treatment you receive from your physical therapist.

By learning about the 5 "D's" of Coman and by watching for any warning signs, you can be sure your physical therapist proceeds safely with treatment for your neck pain or cervical radiculopathy.

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