Childs John D, Flynn Timothy W, Fritz Julie M, Piva Sara R, Whitman Julie M, Wainner Robert S, Greenman Philip E
US Army-Baylor University Doctoral Program in Physican Therapy, Fort Sam Houston, San Antonio, TX, USA.
J Orthop Sports Phys Ther. 2005 May;35(5):300-6. doi: 10.2519/jospt.2005.35.5.300.
Growing evidence supports the effectiveness of manual therapy interventions in patients with neck pain; however, considerable attention has also been afforded to the potential risks such as vertebrobasilar insufficiency (VBI). Despite the existence of guidelines advocating specific screening procedures, research does not support the ability to accurately identify patients at risk. The logical question becomes, "How does one proceed in the absence of certainty?" Given the lack of clear direction for decision making in the peer-reviewed literature, this commentary discusses the uncertainties that exist regarding the ability to identify patients at risk for VBI. The authors hope that this commentary adds additional perspective on manual therapy decision-making strategies in the presence of uncertainty.
