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2. Facilitators and barriers to the implementation of pain neuroscience education in the current Lebanese physical therapist health care approach: a qualitative study.

Author

Najem, C., Wijma, A. J., Meeus, M., Cagnie, B., Ayoubi, F., Van Oosterwijck, J., De Meulemeester, K., and Van Wilgen, C. P.

Subjects
CHRONIC pain, NEUROSCIENCES, PHYSICAL therapy assessment, LUMBAR pain, BIOPSYCHOSOCIAL model, HEALTH services accessibility, NEUROPHYSIOLOGY, PHYSICAL therapy, RESEARCH methodology, MOTIVATION (Psychology), MEDICAL care, LEBANESE, INTERVIEWING, CURRICULUM, HEALTH literacy, QUALITATIVE research, CONTINUING education, PHENOMENOLOGY, PSYCHOSOCIAL factors, QUESTIONNAIRES, DESCRIPTIVE statistics, SOUND recordings, RESEARCH funding, CURRICULUM planning, JUDGMENT sampling, THEMATIC analysis, DATA analysis software, PHYSICIAN practice patterns, PHYSICAL therapists, PHYSICAL therapists' attitudes, THERAPEUTIC alliance, PAIN management
Abstract

The purpose of this paper was first to gain an in-depth understanding of the barriers and facilitators to implementing the BPS model and pain neuroscience education in the current Lebanese physical therapy health care approach and explore its acceptability. A qualitative semi-structured interview using purposive sampling was conducted with eight Lebanese physical therapists practising in different governorates. The transcribed text from the interviews was analyzed using inductive thematic analysis. Two topics were generated and constructed by the researchers: (1) "barriers to the implementation of pain neuroscience education, with subthemes including (a) "current health care approach," (b) "basic curriculum and continuing education," (c) "patients' barriers"; (2) "facilitators to the implementation of pain neuroscience education," with subthemes containing (a) "interest in the BPS model, (b) "therapeutic alliance," and (c) "motivation for future training on BPS approach." The analysis of the results showed that Lebanese physical therapists currently hold a strong biomedical view of chronic pain, assessment, and treatment. However, despite the presence of barriers and challenges, they are aware and open to consider the implementation and future training about the BPS model and pain neuroscience education in their approach. The exploration of potential barriers and facilitators to the bio-psychosocial model and pain neuroscience education implementation may provide an opportunity for better development and design of a culturally sensitive pain neuroscience education material for Arab-speaking and Lebanese physical therapists. The exploration of barriers and facilitators to the implementation of pain neuroscience education will help to improve pain education and ensure better clinical pain management. The most important barriers were the dominant characteristic of the Lebanese physical therapist's health approach, which is focused on a biomechanically oriented model, and their lack of knowledge to approach chronic pain from a biopsychosocial perspective. [ABSTRACT FROM AUTHOR]

Published
2024
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8. Temporal changes in pain processing after whiplash injury, based on Quantitative Sensory Testing: A systematic review

Author

Bontinck, J., Bontinck, J., Lenoir, D., Cagnie, B., Murillo, C., Timmers, I., Cnockaert, E., Bernaers, L., Meeus, M., Coppieters, I., Bontinck, J., Bontinck, J., Lenoir, D., Cagnie, B., Murillo, C., Timmers, I., Cnockaert, E., Bernaers, L., Meeus, M., and Coppieters, I.

Abstract

Background and Objective After whiplash injury, some patients develop chronic whiplash-associated disorders. The exact pathophysiology of this chronification is still unclear and more knowledge is needed regarding the different post-injury phases. Therefore, studies were searched that examined temporal changes in pain processing, measured by Quantitative Sensory Testing (QST). Databases and Data Treatment This systematic review searched three electronic databases (Medline, Web of Science and Embase) for articles meeting the eligibility requirements. Risk of bias was assessed according to a modified Newcastle-Ottawa Scale. Results The 12 included studies presented moderate to good methodological quality. These studies showed altered pain processing within the first month after injury and normalization within 3 months in 59%-78% of the patients. After 3 months, recovery stagnates during the following years. Thermal and widespread mechanical hyperalgesia occur already in the acute phase, but only in eventually non-recovered patients. Conclusions Differences in pain processing between recovering and non-recovering patients can be observed already in the acute phase. Early screening for signs of altered pain processing can identify patients with high risk for chronification. These insights in temporal changes show the importance of rehabilitation in the acute phase. Future research should target to develop a standardized (bed-site) QST protocol and collect normative data which could, in relation with self-reported pain parameters, allow clinicians to identify the risk for chronification. Significance Altered pain processing is present soon after whiplash injury, but usually recovers within 3 months. Non-recovering patients show little to no improvements in the following years. Differences between recovering and non-recovering patients can be observed by Quantitative Sensory Testing already in the acute phase. Therefore, it is considered a feasible and effective tool that

Published
2022

11. Evidence-based behandeling van hoofdpijn in de klinische praktijk : hands-on versus hands-off

Author

Cagnie, B., Chys, M., de Meulenmeester, K., de Pauw, R., Dewitte, V., Mukthar, N., and Meeus, Mira

Subjects
Human medicine
Abstract

Hoofdpijn is een veelvoorkomende klacht in de praktijk van de kinesitherapeut/fysiotherapeut. Migraine, spanningshoofdpijn en cervicogene hoofdpijn zijn de hoofdpijnvormen die het vaakst in de fysiotherapeutische praktijk voorkomen. Voor therapeuten is het de uitdaging om bij iedere patiënt de juiste behandeling te vinden. Dit wordt bemoeilijkt doordat de effectiviteit van fysiotherapie bij ieder hoofdpijntype verschillend is. Voor een evidencebased aanpak is het belangrijk om dit niet alleen te onderbouwen met wetenschappelijk onderzoek, maar ook te baseren op de klinische expertise van de fysiotherapeut zelf. Dit artikel inventariseert de wetenschappelijke evidentie voor de fysiotherapeutische aanpak van hoofdpijn en integreert dit met de klinische expertise aan de hand van de resultaten van een in 2021 gepubliceerde Delphi-studie.

Published
2021

12. Fysiotherapie bij patiënten met whiplashgerelateerde aandoeningen

Author

Lenoir, D., Meeus, Mira, Chys, M., Dewitte, V., Coppieters, I., and Cagnie, B.

Subjects
Human medicine
Abstract

In Europa wordt per jaar zo’n 20 biljoen euro uitgegeven aan (de gevolgen van) whiplashongevallen (een impact ter hoogte van de nek als gevolg van een versnellings- en vertragingsmechanisme bij een botsing). Als gevolg van een dergelijk ongeval kunnen er bepaalde symptomen optreden, waaronder pijn. Hoewel deze symptomen vaak snel verdwijnen, kunnen ze ook langdurig aanhouden, wat het geval is bij 20 tot 50 procent van de patiënten met aan whiplash gerelateerde aandoeningen. Deze patiënten vertonen dikwijls een complexe symptomatologie, wat het vinden van een efficiënte therapie bemoeilijkt. Dit artikel stelt een nieuwe classificatie voor op basis van vier klinische patronen die te onderscheiden zijn bij whiplashpatiënten graad I-II: (1) (sub)acuut stadium met laag risico op chronificatie, (2) (sub)acuut stadium met hoog risico op chronificatie, (3) recurrent stadium met beperkte bijdragende factoren, (4) chronisch stadium met dominante bijdragende factoren. Op basis van deze indeling is de optimale verdeling van educatie, hands-on- en hands-offtechnieken te bepalen, waardoor de therapie meer patiëntspecifiek wordt en de kans op een succesvolle behandeling toeneemt.

Published
2021

17. Evaluating the effectiveness of patient tailored treatment for patients with non‐specific low back pain: A systematic review.

Author

Chys, M., Cagnie, B., De Meulemeester, K., Bontinck, J., Meeus, M., and Dewitte, V.

Subjects
*LUMBAR pain, *ONLINE information services, *MEDICAL information storage & retrieval systems, *SYSTEMATIC reviews, *PHYSICAL therapy, *PATIENT-centered care, *TREATMENT effectiveness, *MEDLINE, *MEDICAL logic
Abstract

Objective: This systematic review summarizes the relevant literature on the effectiveness of tailored interventions in non‐specific low back pain (NSLBP). Methods: The search strategy has been executed in December 2019 in the electronic databases PubMed, Web of Science and Embase. Study selection, data extraction and quality assessment were done independently by two authors. Results: A total six eligible studies were identified. Five out of six articles used a classification system to subgroup patients. All active patient tailored interventions had similar or better results than the non‐patient tailored interventions, most importantly on pain (short‐ and mid‐term, not for long term follow‐up). Two motor control interventions revealed sustained or increased effects at 12 months follow‐up for disability. For cost‐effectiveness, medication use and work absenteeism, results were inconclusive. Global rating of change evaluation confirmed significant between‐group results at 10 weeks to 4 months follow‐up, but results were not maintained at 12‐month evaluation. Discussion & conclusion: Our findings support the preliminary evidence for the use of patient tailored treatment for reductions in pain and disability. However, our results are of very low to moderate quality evidence and the observed effects strongly depend on the subgroups and the chosen interventions. More high‐quality RCT's with homogenous designs and larger sample sizes are needed. [ABSTRACT FROM AUTHOR]

Published
2022
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21. Differences between women with traumatic and idiopathic chronic neck pain and women without neck pain : interrelationships among disability, cognitive deficits, and central sensitization

Author

Coppieters, Iris, De Pauw, Robby, Kregel, Jeroen, Malfliet, Anneleen, Goubert, Dorien, Lenoir, Dorine, Cagnie, B, Meeus, Mira, Pain in Motion, Physical Medicine and Rehabilitation, Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, and Vrije Universiteit Brussel

Subjects
Adult, Cognition Disorders/diagnosis, Neck Pain/diagnosis, Physical Therapy, Sports Therapy and Rehabilitation, Case-control studies, Middle Aged, Disability Evaluation, Cross-Sectional Studies, Whiplash Injuries/complications, Surveys and Questionnaires, Humans, young adult, Disabled Persons, Female, Human medicine, Central Nervous System Sensitization/physiology, chronic pain, Quality Of Life, Pain Measurement
Abstract

Background. To date, a clear differentiation of disability, cognitive deficits, and central sensitization between chronic neck pain of a traumatic nature and that of a nontraumatic nature is lacking. Objective. This study aimed to examine differences in disability, cognitive deficits, and central sensitization between women with traumatic and idiopathic (nontraumatic) chronic neck pain and women who were healthy. In addition, interrelationships among these variables were investigated. Design. This was a case-control study. Methods. Ninety-five women (28 women who were healthy [controls], 35 women with chronic idiopathic neck pain [CINP], and 32 women with chronic whiplash-associated disorders [CWAD] [traumatic]) were enrolled in the study. First, all participants completed standardized questionnaires to investigate pain-related disability and health-related quality of life. Next, cognitive performance was assessed. Finally, pressure pain thresholds and conditioned pain modulation were examined to investigate central sensitization. Results. Pain-related disability, reduced health-related quality of life, and cognitive deficits were present in participants with CWAD and, to a significantly lesser extent, in participants with CINP. Local hyperalgesia was demonstrated in participants with CWAD and CINP but not in women who were healthy. However, distant hyperalgesia and decreased conditioned pain modulation efficacy were shown only in participants with CWAD; this result is indicative of the presence of central sensitization. Moderate to strong Spearman correlations (rho=.456-.701) among disability, cognitive deficits, and hyperalgesia (local and distant) were observed in participants with CWAD. In participants with CINP, only local hyperalgesia and subjective cognitive deficits were moderately (rho=.463) correlated. Limitations. No conclusions about the causality of the observed correlations can be drawn. Conclusions. This innovative research revealed important differences between women with CWAD and women with CINP and thus provided evidence of the clinical importance of distinguishing the assessment and rehabilitation approaches for both pain conditions.

Published
2017

23. The efficacy of manual therapy and exercise for treating non-specific neck pain: A systematic review

Author

Hidalgo, B., Hall, Toby, Bossert, J., Dugeny, A., Cagnie, B., Pitance, L., Hidalgo, B., Hall, Toby, Bossert, J., Dugeny, A., Cagnie, B., and Pitance, L.

Abstract

© 2017 - IOS Press and the authors. All rights reserved. OBJECTIVE: To review and update the evidence for different forms of manual therapy (MT) and exercise for patients with different stages of non-specific neck pain (NP). Data sources: MEDLINE, Cochrane-Register-of-Controlled-Trials, PEDro, EMBASE. METHOD: A qualitative systematic review covering a period from January 2000 to December 2015 was conducted according to updated-guidelines. Specific inclusion criteria only on RCTs were used; including differentiation according to stages of NP (acute - subacute [ASNP] or chronic [CNP] ), as well as sub-classification based on type of MT interventions: MT1 (HVLA manipulation); MT2 (mobilization and/or soft-tissue-techniques); MT3 (MT1 + MT2); and MT4 (Mobilization-with-Movement). In each sub-category, MT could be combined or not with exercise and/or usual medical care. RESULTS: Initially 121 studies were identified for potential inclusion. Based on qualitative and quantitative evaluation criteria, 23 RCTs were identified for review. Evidence for ASNP: MODERATE-evidence: In favour of (i) MT1 to the cervical spine (Cx) combined with exercises when compared to MT1 to the thoracic spine (Tx) combined with exercises; (ii) MT3 to the Cx and Tx combined with exercise compared to MT2 to the Cx with exercise or compared to usual medical care for pain and satisfaction with care from short to long-term. Evidence for CNP: STRONG-evidence: Of no difference of efficacy between MT2 at the symptomatic Cx level(s) in comparison to MT2 on asymptomatic Cx level(s) for pain and function. MODERATE to STRONG-evidence: In favour of MT1 and MT3 on Cx and Tx with exercise in comparison to exercise or MT alone for pain, function, satisfaction with care and general-health from short to moderate-terms. MODERATE-evidence: In favour (i) of MT1 as compared to MT2 and MT4, all applied to the Cx, for neck mobility, and pain in the very short term; (ii) of MT2 using sof-tissue-techniques to the Cx and T

Published
2017

28. Cognitive performance is related to central sensitization in patients with chronic whiplash-associated disorders and fibromyalgia: a case-control study

Author

Coppieters, Iris, Ickmans, Kelly, Cagnie, B., Nijs, Jo, De Pauw, Robby, Noten, Suzie, Meeus, Mira, Human Physiology and Special Physiology of Physical Education, Rehabilitation and Physiotherapy, Spine Research Group, and Motor Mind

Abstract

BACKGROUND: A growing body of research has demonstrated that impaired central pain modulation or central sensitization (CS) is a crucial mechanism for the development of persistent pain in chronic whiplash-associated disorders (WAD) and fibromyalgia (FM) patients. Furthermore, there is increasing evidence for cognitive dysfunctions among these patients. In addition, chronic WAD and FM patients often report problems with health-related quality of life (QoL). Yet, there is limited research concerning the interrelations between cognitive performance, indices of CS, and health-related QoL in these patients. OBJECTIVES: (1) Examining the presence of cognitive impairment, CS, and limitations on health-related QoL in patients with chronic WAD and FM compared to healthy controls. (2) Examining interrelations between performance-based cognitive functioning, CS, and self-reported health-related QoL in these 3 study groups. STUDY DESIGN: A case-control study was conducted. SETTING: The present study took place at the University Hospital Brussels, the University of Brussels, and the University of Antwerp. METHODS: Fifty-nine patients (16 chronic WAD patients, 21 FM patients, and 22 pain-free volunteers) filled out the Short Form 36 item Health Survey (SF-36), a self-reported psychosocial questionnaire, to assess health-related QoL. Next, they were subjected to various pain measurements (pressure hyperalgesia, deep-tissue hyperalgesia, temporal summation [TS], and conditioned pain modulation [CPM]). Finally, participants completed a battery of performance-based cognitive tests (Stroop task, psychomotor vigilance task [PVT], and operation span task [OSPAN]). RESULTS: Significant cognitive impairment, bottom-up sensitization, and decreased health-related QoL were demonstrated in patients with chronic WAD and FM compared to healthy controls (P < 0.017). CPM was comparable between the 3 groups. Cognitive performance was significantly related to central pain modulation (deep-tissue hyperalgesia, TS, CPM) as well as to self-reported health-related QoL (P < 0.05). Decreased cognitive performance was related to deficient central pain modulation in healthy controls. Further, significant correlations between decreased cognitive performance and reduced health-related QoL were revealed among all study groups. Additionally, FM patients showed correlations between cognitive impairment and increased health-related QoL. Remarkably, impaired selective attention and working memory were related to less TS, whereas impaired sustained attention was correlated with dysfunctional CPM in FM patients. LIMITATIONS: Based on the current cross-sectional study no firm conclusions can be drawn on the causality of the relations. CONCLUSION: In conclusion, this paper has demonstrated significant cognitive deficits, signs of CS, and reduced health-related QoL in chronic WAD and FM patients compared to healthy individuals. Significant relations between cognitive performance and CS as well as health-related QoL were demonstrated. These results provide preliminary evidence for the clinical importance of objectively measured cognitive deficits in patients with chronic WAD and FM. KEY WORDS: Chronic pain, fibromyalgia, whiplash, central sensitization, conditioned pain modulation, temporal summation, cognition, quality of life.

Published
2015

31. A modern neuroscience approach to chronic spinal pain: combining pain neuroscience education with cognition-targeted motor control training

Author

jo nijs, Mira Meeus, Cagnie, B., Nathalie Roussel, Jessica Van Oosterwijck, Lieven Danneels, Human Physiology and Special Physiology of Physical Education, Rehabilitation and Physiotherapy, and Rehabilitation Research

Subjects
chronic, animal structures, nervous system, musculoskeletal, neural, and ocular physiology, fungi
Abstract

A modern neuroscience approach to chronic spinal pain: combining pain neuroscience education with cognition-targeted motor control training

Published
2014

43. Are pain, disability, quality of life, psychological factors and central sensitization related to quantitative sensory testing in chronic whiplash associated disorders?

Author

Lenoir, D., Willaert, W., Ickmans, K., Bernaers, L., Nijs, J., Malfliet, A., Danneels, L., Leysen, L., De Pauw, R., Cagnie, B., Coppieters, I., and Meeus, M.

Subjects
WHIPLASH injuries, FUNCTIONAL status, CHRONIC diseases, CONFERENCES & conventions, PAIN threshold, QUALITY of life, PSYCHOLOGY of the sick, DISEASE complications
Abstract

Introduction: Chronic Whiplash Associated Disorders (CWAD) are characterized by long-lasting symptoms of neck pain occurring after an acceleration-deceleration injury. Central sensitization (CS) has been suggested as the possible underlying mechanism for these symptoms, and is characterized by changes in the central nervous system. Besides CS, psychological factors are believed to play an important role in the experience of (chronic) pain. Methods: 72 CWAD patients and 55 healthy controls underwent electrical stimuli-based quantitative sensory testing (QST). Detection and pain thresholds (EPT), temporal summation (TS) and conditioned pain modulation (CPM) were examined. Spearman correlations and linear mixed models analyses were performed to assess respectively the hypothesized associations with and group differences in QST. Results: The Pain Catastrophizing magnification subscale correlated with left wrist EPT (r = -0.332; p = 0.004), and the Pain Anxiety Symptom Scale-20 with left wrist (r = -0.325; p = 0.005) and ankle (r = -0.330; p = 0.005) EPT. TS at the ankle correlated with the CS Inventory (r = 0.303; p = 0.010), Short Form 36 pain subscale (r = -0.325; p = 0.005), and Illness Perception Questionnaire revised consequences subscale (r = 0.325; p = 0.005). EPTs of left (p = 0.011) and right wrist (p = 0.023) were lower in the CWAD group, but CPM and TS did not differ between groups. Discussion: QST outcomes relate to psychological constructs, rather than to self-reported pain intensity and distribution. Local hyperalgesia was found in CWAD patients, but no differences in endogenous pain facilitation nor inhibition. Process evaluation: Both CWAD patients reporting unilateral as bilateral neck pain were included, which complicated the interpretation of distal hyperalgesia. [ABSTRACT FROM AUTHOR]

Published
2022
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44. The effect of praying on endogenous pain modulation and pain intensity in healthy religious individuals: A randomized controlled experiment.

Author

Najem, C., Meeus, M., Cagnie, B., Ayoubi, F., Al Achek, M., Van Wilgen, P., Van Oosterwijck, J., and K., De Meulemeester

Subjects
PRAYER, PAIN measurement, CONFERENCES & conventions, RANDOMIZED controlled trials, PSYCHOLOGY & religion, PAIN management, RELIGION
Abstract

Introduction: Prayer is the most common therapy used in alternative medicine1. The objective of this study was to explore the effect of prayers on endogenous pain modulation, pain intensity, and sensitivity in healthy religious participants. Methods: Two hundred and eight healthy religious participants were enrolled in this study and randomly distributed into two groups, a prayer group (n = 156) and a poem reading or control group (n = 52). Participants from the prayer group were allocated to either an active prayer group (n = 94) receiving an active type of praying or to a passive prayer group (n = 62) receiving a passive type of praying. Pain assessments were performed prior to and following the prayer or poem reading interventions and included pressure pain threshold assessment, conditioned pain modulation, and a numerical pain rating scale for perceived pain intensity. Results: A significant group-by-time interaction for PPT (p = 0.014) indicated post-intervention increases in PPT in the prayer group but not in the poem reading control group. Also, a significant group-by-time interaction for PPT (p = 0.005) indicated that these effects were greater in the active prayer group than in the passive prayer group. Participants experienced a decrease in CPM efficacy (p = 0.030) and an increase in pain intensity (p < 0.001) following the interventions, independent of their group allocation. Discussion: The results showed that prayer, irrespective to type, can positively affect pain sensitivity and intensity, but does not influence endogenous pain inhibition. Process evaluation: Future research should focus on understanding the mechanism behind "prayer induced analgesia". [ABSTRACT FROM AUTHOR]

Published
2022
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45. Neural processing of pain-related distress to cervical specific movements in people with chronic pain after whiplash injury.

Author

Murillo, C., Coppieters, I., Bernaers, L., Cagnie, B., Meeus, M., and Timmers, I.

Subjects
BRAIN physiology, CHRONIC pain, CERVICAL vertebrae, WHIPLASH injuries, CONFERENCES & conventions, PSYCHOLOGICAL stress, DISEASE complications
Abstract

Introduction: Recent fMRI studies have revealed altered activations in key regions for threat and affective processing of pain in motor imagination tasks. Yet, research in this vein is still lacking in people with chronic whiplash (CWAD). Methods: Sixty CWAD and 32 pain-free participants were included. In the scanner, participants were presented with pictures divided into 3 categories (5 weight bearing, 5 non-weight bearing and 5 neutral pictures) taken from the Pictorial Fear of Activity Scale-Cervical***questionnaire (jittered event-related design). After the scanning, participants were asked to rate each picture in terms of worry, desire to avoidance, anxiety, expected pain. SPM software was used for pre-processing and analysis of the fMRI data. Results: Whole brain analysis revealed greater activation in CWAD for the contrast weight bearing versus neutral pictures in planum temporale/parietal operculum, post/pre-central gyrus, frontal pole, precuneus and posterior cingulate. CWAD have greater activation in precuneus and cerebellum in the non-weight bearing versus neutral contrast. CWAD scored pictures higher than controls, but no correlation between scores and the identified clusters was found. Discussion: The results from this study allow for a better understanding of the maladaptive pain cognitions associated with CWAD by investigating the underlying neural activity alterations. Process evaluation: Several challenges were encountered along the way (data collection and analyses) as this was my first fMRI study. [ABSTRACT FROM AUTHOR]

Published
2022
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47. A case of abnormal findings in the course of the vertebral artery associated with an ossified hyoid apparatus. A contradiction for manipulation of the cervical spine?

Author

Cagnie, B., Barbaix, Erik, Vinck, E., D'herde, K., Cambier, D., Anatomy, and Vrije Universiteit Brussel

Subjects
neck muscles, hyoid bone, vena cava, superior, cervical vertebrae, manipulation, spinal, Vertebral artery
Abstract

Objective: To describe a case of a simultaneous occurrence of an ossified stylohyoid ligament in a 56-year-old male cadaver and anomalies of the vertebral artery, and to consider the clinical implications for manipulative therapists. Intervention and Outcome: Dissection showed a simultaneous occurrence of complete developmental ossification of the left hyoid apparatus, variants of the vertebral artery, and a left superior vena cava in a 56-year-old male cadaver. Discussion: Developmental variants, posttraumatic and degenerative changes of the hyoid apparatus may result in variable degrees of ossification or calcification. Conclusion: This unusual disorder should be considered in the differential diagnosis of facial and neck pain especially within the scope of manipulation of the upper cervical spine. Cervical spine manipulation may exacerbate existing pathological conditions of the stylohyoid apparatus, thereby irritating neurovascular structures, and induce a fracture. Developmental ossification of this apparatus might be associated with anomalies in the atlantic section of the vertebral artery which make the patient more susceptible to vertebrobasilar insufficiency. We conclude that extreme care should be taken in the presence of such an ossification to avoid trauma to the stylohyoid apparatus and maybe even because of increased vertebrobasilar risk.

Published
2005

48. Changes in cerebellar blood flow after manipulation of the cervical spine using Technetium 99mm-ethyl cysteinate dimer

Author

Barbaix, Erik, Cagnie, B., Jacobs, F., Vinck, E., Dierckx, R., Cambier, D., Anatomy, and Vrije Universiteit Brussel

Subjects
hypoperfusion, manipulation, tomography, emission-computed, single-photon, neck, regional blood flow
Abstract

Background: Cervical spine manipulation is one of the many interventions practiced by health professionals to treat musculoskeletal disorders of the cervical spine. Although serious consequences of manipulation have been documented, the incidence is thought to be rare. More frequently, there may be minor transient side effects after manipulation of the cervical spine, such as headache, dizziness, and nausea. One of the hypothesis is that these side effects are caused by ischemia in the areas perfused by the vertebral arteries. Objective: The purpose of this study was to investigate whether manipulation of the cervical spine can influence blood flow in the brain. Methods: Single photon emission computed tomography was used to examine changes in regional cerebral blood flow caused by cervical spine manipulation (CSM) performed by a physiotherapist to 15 volunteers, using a 1-day split-dose Technetium 99m-ethyl cysteinate dimer single photon emission computed tomography activation paradigm. Results: One brain region was identified showing a decreased regional cerebral blood flow after manipulation. This region was situated in the anterior lobe of the left cerebellum (-42, -48, -24). Conclusions: These findings suggest that cerebellar hypoperfusion may occur after CSM. This could explain why certain people experience headache, dizziness, or nausea after CSM. Further investigation into patient symptoms in the presence of cerebellar hypoperfusion and the possible link of these findings with other adverse reactions are warranted.

Published
2005

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