Identifying vascular pathologies or flow limitations: Important aspects in the clinical reasoning process.

Cervical spine manipulation and mobilisation are frequently used in the management of neck pain and headache. Although very rare, serious adverse events (SAEs) following cervical spine manipulation and mobilisation have been described. Recently, a revised version of the International IFOMPT Cervical Framework was published, to provide guidance for the assessment of the cervical spine region for potential vascular pathologies of the neck in advance of planned Orthopaedic Manual Physical Therapy (OMPT) interventions. Clinicians should realise that following the Framework does not guarantee that vascular pathologies or flow limitations will be identified. To illustrate this, in this Professional Issue, we use a case description of a SAE that occurred in the Netherlands during a mobilisation technique used by a physiotherapist and discuss this case using the IFOMPT Cervical Framework and highlight some important aspects in the clinical reasoning process.