School of Health and Rehabilitation Sciences, University of Queensland, Australia.
School of Health and Rehabilitation Sciences, University of Queensland, Australia.
Musculoskelet Sci Pract. 2020 Apr;46:102095. doi: 10.1016/j.msksp.2019.102095. Epub 2019 Nov 18.
Positional testing for vertebrobasilar insufficiency (VBI) is used by physiotherapists as part of pre-manipulative screening protocols. Recently, the validity of the tests have been questioned because a negative test does not infer safety with cervical manipulative therapy but the reasoning surrounding this opinion may be questioned. While the positional tests were developed to test vertebral artery flow contralateral to the direction of head movement and the subsequent effect on cerebral blood supply, as inferred by symptom reproduction, ultrasound studies have shown that vertebral artery flow is inherently variable. Rather, the tests should be considered as testing for adequacy of collateral flow in particular head positions rather than decreased blood flow in a particular artery, with more attention to characteristics of symptom reproduction. We contend that positional testing for VBI remains valuable for testing adequacy of collateral flow, and also has an important place as part of the differential diagnosis of individuals with dizziness or imbalance. The physiotherapist's ability to differentially diagnose dizziness and recognise the presence or not of VBI is not only critical for prompt medical investigation and management because it is a risk factor for transient ischaemic events and stroke, but has important influences over management decisions regarding cervical musculoskeletal treatment including exercise interventions. Importantly, the positional tests should not be considered as tests of arterial integrity and used to assess the risk of damage to the vertebral or internal carotid artery or presence of cervical arterial dissection. Urgent research is needed before we abandon positional testing prematurely.
位置性试验用于椎基底动脉供血不足（VBI），是物理治疗师在进行手法治疗前筛选的一部分。最近，这些测试的有效性受到了质疑，因为阴性测试并不能推断颈椎手法治疗的安全性，但这种观点的推理可能值得商榷。虽然位置性试验是为了测试与头部运动方向相反的椎动脉血流以及随后对脑血流供应的影响（通过症状再现推断）而开发的，但超声研究表明，椎动脉血流本身就是多变的。相反，这些测试应该被认为是在特定头部位置测试侧支循环血流的充足性，而不是特定动脉的血流量减少，更多地关注症状再现的特征。我们认为，VBI 的位置性测试对于测试侧支循环血流的充足性仍然是有价值的，并且作为头晕或失衡个体的鉴别诊断的一部分也具有重要地位。物理治疗师区分头晕并识别 VBI 是否存在的能力不仅对及时进行医学调查和管理至关重要，因为它是短暂性脑缺血发作和中风的危险因素，而且对包括运动干预在内的颈椎肌肉骨骼治疗的管理决策也有重要影响。重要的是，位置性测试不应被视为动脉完整性的测试，也不能用于评估椎动脉或颈内动脉损伤的风险，或颈动脈夹层的存在。在我们过早地放弃位置性测试之前，需要进行紧急研究。
