Rationale Use of Manipulation in Cervical Spine Disorders Timothy W. Flynn, PT, PhD Board Certified in Orthopaedic Fellow, American Academy of Orthopaedic Manual Physical Therapists

Session Description: There is always risk associated with the management of patient with head and neck disorders. Frequently injury to the vertebral artery is mentioned as a complication of cervical manipulation. Controversy continues on the magnitude of that risk and often to the exclusion of potentially more common risks such as missed diagnosis. The purpose of this session is the to review the current literature and discuss a framework of best practice risk in context when managing individuals with head and neck complaints.

Lecture Slides May Change Prior to the Conference

Dr. Flynn is an expert clinician and owner of Colorado Physical Therapy Specialists where he is dedicated to providing the highest quality care possible. His primary clientele is made up of individuals suffering from low back pain, chronic spinal disorders, failed back surgeries, and chronic pain disorders. He is on the executive board of Evidence in Motion Institute for Health Professions, which passionately promotes a culture of evidence-based practice within the physical therapy profession. Dr. Flynn is the immediate past President of the American Academy of Orthopaedic Manual Physical Therapists and an Associate Editor for the Journal of Orthopaedic & Sports Physical Therapy (JOSPT). He is a Distinguished Professor at Rocky Mountain University of Health Professions where he teaches professional and post-professional students in the area of musculoskeletal management, advanced manipulation skills, and evidence based practice.

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Douglass AB, Bope ET. Evaluation and treatment of posterior neck pain in family practice. J Am Board Fam Pract 2004;17:S13-S22. Guez M, et al. Chronic neck pain of traumatic and non-traumatic origin. Acta Orthop Scand 2003;74:576-579

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Cassidy JD, et al. Risk of vertebrobasilar stroke and chiropractic care. Spine 2008;33:S176-S183.

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Primal Software Chiropractic Techniques

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Spinal & Extremity Manipulation: The Basic Skill Set for Physical Therapists. - Wainner, Flynn, and Whitman. ISBN 0-9714792-1-6, 2001.

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1 Tannenebaum et al. Can Med Assoc J 155:77-88, 1996; 2 Hungin & Kean. Am J of Medicine 110:8S-11S, 2001; 3 Tamblyn, et al. Ann Int Med 127:429-438, 1997; 4 Arthritis Advisory Panel- FDA, Feb 08, 2001 & 2005. 5 Arthritis Advisory Panel- FDA, 2009

U.S. Mortality Data for Seven Selected Disorders in 1997

In the United States in 1997, non-steroidal anti-inflammatory drugs killed as many people as died from AIDS.

Wolfe M et al. N Engl J Med 1999;340:1888-1899

!-*W(-%(0$%9'\9( X$T'2'1\!-5#$!*)4%3-!4')!/#%!4-! /)$-$#'%39!4-!-F**)/!*)4%3M! Reported Risk per Potential Intervention 10,000 Complication Cervical Spine Paralysis, Stroke, Death Manipulation 0.005 Low Estimate Vigorous Exercise 0.002 Sudden Death Cervical Spine Manipulation 0.9 Paralysis, Stroke, Death High Estimate NSAIDS 100 – 300 GI bleed NSAIDS- with Death developed bleed 20

9 Coroner's Jury Concludes ! Neck Manipulation ! Killed Canadian Woman!

… the most serious threat to chiropractic's credibility comes from the saturation media coverage it has received — in the Toronto area there have been dozens of newspaper and broadcast reports.

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Proceeding in the Absence of Certainty

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Lisa Carlesso (Canada, subject expertise) Dr Tim Flynn (USA, subject expertise) Dr Wayne Hing (NZ, subject expertise) Roger Kerry (UK, subject expertise) Professor Darren Rivett (Australia, subject expertise and IFOMPT Standards Committee) Dr Alison Rushton (UK, Chair IFOMPT Standard Committee)

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Haldemann, Spine, 2002

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Now We Are Talking…So Where Should I Begin >F<<4'9! With My Manual Therapy Treatments?

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