J Manipulative Physiol Ther. 1994 Jan; 17(1): 15-9.

Rotation: a valid premanipulative dizziness test? Does it predict safe manipulation?

Refshauge KM.

School of Physiotherapy, Faculty of Health Sciences, University of Sydney, Lidcombe, Australia.

OBJECTIVE: The purpose of this study was to investigate the validity of cervical spine rotation as a test of patency of the vertebral arteries (VAs) and the internal carotid arteries (ICAs). DESIGN: A descriptive study was undertaken. SETTING: Testing was carried out in a private clinical vascular unit attached to a large Sydney public hospital. PARTICIPANTS: Twenty healthy volunteers, both male and female, who were free of risk factors commonly associated with vascular disease, participated in the study. INTERVENTIONS AND MAIN OUTCOME MEASURES: An AutoSector 5 Duplex Doppler ultrasound instrument was used to record mean and peak frequency of blood flow (a measure of blood velocity) in the right and left VAs and ICAs in the cervical spine positions of neutral, 45 degrees contralateral rotation and full range contralateral rotation. To determine general hemodynamic stability, blood pressure and heart rate were recorded pre- and posttest, as well as in all tested positions. RESULTS: There was a significant trend for blood velocity to increase in 45 degrees contralateral rotation and to decrease in full rotation (p < .01). This trend was not consistent across vessels. Blood velocity decreased with rotation from neutral head position in the right VA, and continued to increase throughout rotation in the right ICA. CONCLUSION: It appears that sustained rotation influences blood velocity in the extracranial vessels. This may have relevance in patients with abnormal blood flow who are candidates for cervical manipulation.