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manuelletherapie 2007; 11(5): 229-239
DOI: 10.1055/s-2007-963707
Literaturstudie

© Georg Thieme Verlag KG Stuttgart · New York

Manipulation der HWS und Evidenzbasierte Medizin[1]

Literaturstudie zur Manipulation für PhysiotherapeutenManipulation of the Cervical Spine and Evidence Based MedicineLiterature Review Concerning Manipulation for PhysiotherapistsJ. Schomacher
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Publication History

Manuskript eingetroffen: 2.8.2006

Manuskript akzeptiert: 18.9.2006

Publication Date:
07 December 2007 (online)

Also available atphysioLink
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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

1 Die vorliegende Arbeit wurde ohne finanzielle Unterstützung, den Auftrag einer Vereinigung oder Institution in Eigeninitiative erstellt.

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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