Zusammenfassung
Besonders die Manipulation an der HWS beinhaltet ein seltenes, aber doch dramatisches
Risiko vor allem (zerebro-) vaskulärer Komplikationen. Anhand einer Literaturanalyse
untersucht die vorliegende Arbeit die Merkmale der Manipulation im Hinblick auf diese
Risiken. Die Arten und Häufigkeiten der Komplikationen werden beschrieben. Der Schwerpunkt
liegt auf der vertebrobasilären Insuffizienz, für die prämanipulative Tests keine
Hinweise liefern. Die Verlängerung der Arterie ebenso wie die hohe Geschwindigkeit
der Bewegung als dazu führende Mechanismen werden diskutiert. Das größte Risiko scheinen
Rotationsbewegungen zu bergen. Es fanden sich weder Studien, die gezielt die Risiken
der für Physiotherapeuten empfohlenen geradlinigen translatorischen Manipulationen
untersuchen, noch solche mit Wirkungsvorteilen der Manipulation gegenüber der Mobilisation.
Das Risiko-Nutzen-Verhältnis der Manipulation sowie Empfehlungen zu ihrem Erlernen
werden erörtert.
Abstract
Especially cervical spine manipulation involves a rare but still dramatical risk particularly
of (cerebro-) vascular complications. By means of a literature analysis this article
investigates the characteristics of manipulation in view of these risks. Types and
frequencies of complications are described. The main focus lies on vertrebobasilar
insufficiency which cannot be detected by premanipulative tests. Arterial elongation
as well as the high velocity used are discussed as possible mechanisms for this. Rotation
movements seem to be fraught with risks. No studies were found that specifically examine
the risks of linear translatory manipulations as recommended for physiotherapists
or that show beneficial effects of manipulation compared to mobilisation. Risk-benefit
ratio of manipulation as well as recommendations for learning manipulation are reconsidered.
Schlüsselwörter
Manipulation - Rotation - Translation - Risiken - vertebrobasiläre Insuffizienz -
Evidenz-basierte Medizin
Key words
manipulation - rotation - translation - risks - vertebrobasilar insufficiency - evidence
based medicine
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1 Die vorliegende Arbeit wurde ohne finanzielle Unterstützung, den Auftrag einer Vereinigung
oder Institution in Eigeninitiative erstellt.
Jochen Schomacher
Dorfstr. 24
CH-8700 Küsnacht ZH
Email: Jochen-Schomacher@web.de