Physiospot Musculoskeletal

Blood Investigations in Advanced Musculoskeletal Practice at Sheffield Hallam University

This course is designed for physiotherapists working or developing towards an Advanced Practice/Extended Scope role.

The module aims to develop an understanding of
• blood investigations in advanced musculoskeletal practice
• the consequences of such investigations
• how blood investigations might influence patient management.

The module will promote reflection on the practitioners' clinical role and scope of practice and will include the practical skills around taking blood. Successful completion of this module will earn you 15 level 7 credits which may be put towards the MSc Advancing Physiotherapy.

Provisional Timetable
Fri 3rd Oct, Fri 24th Oct, Fri 7th Nov, Fri 21st Nov, Fri 12th Dec.

More Information

Cervical arterial dysfunction and manual therapy: A critical literature review to inform professional practice

Roger Kerry, Alan J. Taylor, Jeanette Mitchell and Chris McCarthy

This paper presents a critical, re-examination of relevant literature with the aim of providing a contemporary, evidence-informed review of key areas regarding the neurovascular risks of cervical spine manual therapy.

From a consideration of case reviews and surveys, haemodynamic principles, and blood flow studies, the authors suggest that: (1) it is currently impossible to meaningfully estimate the size of the risk of post-treatment complications; (2) existing testing procedures have limited clinical utility; and (3) a consideration of the association between pre-existing vascular risk factors, combined with a system based approach to cervical arterial haemodynamics (inclusive of the carotid system), may assist manual therapists in identifying at-risk patients.

Manual Therapy, 2008, 13(4), 278-288

Link to Abstract

Decreased Pulsatile Blood Flow in the Patella in Patellofemoral Pain Syndrome

Jan Näslund, Markus Waldén and Lars-Göran Lindberg

The objective of this study was to investigate whether fllexing the knee joint interferes with the perfusion of the patellar bone in patellofemoral pain syndrome.  22 patients with patellofemoral pain syndrome were examined bilaterally, and 33 subjects with healthy knees served as controls. Pulsatile blood flow in the patella was measured in a resting position with knee flexion of 20° and after passive knee flexion to 90°. The pulsatile blood flow in the patient group decreased after passive knee flexion from 20° to 90° while the response in the control group showed no distinct pattern.

Pulsatile patellar blood flow in patellofemoral pain syndrome patients is markedly reduced when the knee is being flexed, which supports the previous notion of an ischemic mechanism involved in the pathogenesis of this pain syndrome.

The American Journal of Sports Medicine, 2007, 35, 1668-1673

Link to abstract

The etiology of cervical artery dissection

Michael Haneline and Anthony Rosner

The etiology of cervical artery dissection (CAD) is unclear, although a number of risk factors have been reported to be associated with the condition. On rare occasions, patients experience CAD after cervical spine manipulation, making knowledge about the cervical arteries, the predisposing factors, and the pathogenesis of the condition of interest to chiropractors. This commentary reports on the relevant anatomy of the cervical arteries, developmental features of CAD, epidemiology of the condition, and mechanisms of dissection. The analysis of CAD risk factors is confusing, however, because many people are exposed to mechanical events and known pathophysiological associations without ever experiencing dissection. No cause-and-effect relationship has been established between cervical spine manipulation and CAD, but it seems that cervical manipulation may be capable of triggering dissection in a susceptible patient or contributing to the evolution of an already existing CAD. Despite the many risk factors that have been proposed as possible causes of CAD, it is still unknown which of them actually predispose patients to CAD after cervical spine manipulation.

Journal of Chiropractic Medicine, 2007, 6(3), 110-120

Link to Abstract

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The Relationship Between Magnetic Resonance Imaging Findings and Postural Maneuver and Physical Examination Tests in Patients With Thoracic Outlet Syndrome: Results of a Double-Blind, Controlled Study

Derya Demirbag, Ercument Unlu, Ferda Ozdemir, Hakan Genchellac, Osman Temızoz, Huseyın Ozdemır and M. Kemal Demır

The objective of this study was to investigate the differences in findings from magnetic resonance imaging (MRI) in the neutral and provocative positions, and to examine the relationship between these differences and the results of physical examination tests in patients with thoracic outlet syndrome (TOS).  Twenty-nine patients had positive bilateral TOS stress tests and 12 healthy control group participants were symptom free and had negative TOS stress tests bilaterally.  All participants underwent Adson’s test, the Halsted maneuver, and a hyperabduction test. All were evaluated with MRI while in 2 positions: the neutral position (upper extremities adducted) and in a provocative position. Measurements were obtained at the interscalene triangle, at the costoclavicular space, and at the retropectoralis minor space.  There was a significant difference in MRI findings between the neutral and provocative position in the patients, but there were no significant differences in the control group. There was a significant difference in the positional change values in MRI between the patients and the control subjects. The difference was found in the minimum costoclavicular distance between patients with a positive Halsted maneuver and a negative Halsted maneuver.  The authors conclude that their findings indicate that MRI findings in patients in a provocative position are more valuable in the diagnosis of TOS, and these findings are in accord with findings from the physical evaluation tests.

Archives of Physical Medicine and Rehabilitation, 2007, 88(7), 844-851

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Dynamic vertebral artery elongation during frontal and side impacts

Erik J. Carlson, Yasuhiro Tominaga, Paul C. Ivancic and Manohar M. Panjabi

Elongation-induced vertebral artery (VA) injury has been hypothesized to occur during nonphysiological coupled head motions during automobile impacts. Although previous work has investigated VA elongation during head-turned and head-forward rear impacts, no studies have performed similar investigations for frontal or side impacts.  The purpose of this study was to quantify dynamic VA elongations during simulated frontal and side automotive collisions, and compared these data with corresponding physiological limits.  A biofidelic whole cervical spine model with muscle force replication and surrogate head underwent simulated frontal impacts or left side impacts. The authors conclude that elongation-induced VA injury is more likely to occur during side impact as compared with frontal impact.

The Spine Journal, Volume 7, Issue 2, March-April 2007, Pages 222-228

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Cervical arterial dysfunction assessment and manual therapy

Roger Kerry and Alan J. Taylor

This paper presents a clinical overview of cervical arterial dysfunction (CAD) for manual therapists who treat patients presenting with cervical pain and headache syndromes. An overview of vertebrobasilar arterial insufficiency (VBI) is given, with reference to assessment procedures recommended by commonly used guidelines. A holistic and evidence-based approach to CAD is presented and considers typical pain patterns and clinical progressions of both vertebrobasilar, and internal carotid arterial pathologies.  The authors suggest that consideration of the information provided in this Masterclass will enhance the manual therapist's clinical reasoning with regard to differential diagnosis of cervical pain syndromes, and prediction of serious adverse reactions to treatment.

Manual Therapy, Volume 11, Issue 4, November 2006, Pages 243-253

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Cervical Artery Insufficiency and Manipulative Therapy- A Literature Review

This review was commissioned by the Manipulation Association of Chartered Physiotherapists (MACP) in response to demands from the MACP membership. The demands suggested an uncertainty among the members regarding the nature of arterial insufficiency related to the cervical spine (commonly referred to as vertebrobasilar insufficiency (VBI)), the risks of manual therapy with respect to such arterial complications, and the MACP's position on pre-cervical spine treatment screening. This review attempts to provide an evidence-based information source to further facilitate clinicians understanding of the effect of manual therapy on the cervical spine with regards to cervical blood flow.

Published on the MACP website.

View Clincal Summary and New Cervical Artery Assessment Framework.

Assessment of neuromuscular and haemodynamic activity in individuals with and without chronic low back pain

Melissa D McKeon, Wayne J Albert, J Patrick Neary

This study was designed to examine the haemodynamic and neuromuscular activity of the erector spinae, biceps femoris, and gluteus maximus musculature during the Biering-Sørenson Muscular Endurance Test (BSME). The study concludes that although the BSME has been recognized as a test for back endurance, individuals with chronic LBP appear to incorporate a strategy that may help support the back musculature by utilizing the biceps femoris and gluteus maximus to a greater degree than their healthy counterparts.

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