Home » Section 1: Context to assessment of the cervical region

Section 1: Context to assessment of the cervical region


IFOMPT’s vision is to promote global progress and uniformity in clinical and academic standards for manual/musculoskeletal physical therapists whose mission includes working towards international uniformity/educational standards of functional compatibility between them manual/musculoskeletal and orthopedic physical therapists. The development of this strategy is guided by this vision and mission, which began in 2007 to examine the key issues.

Process of development

At the World Physical Therapy Congress in Vancouver (2007), IFOMPT organized a panel of speakers and discussions entitled ‘VBI [vertebro-basilar insufficiency] forum’ to address a topic that provides frequently asked questions from IFOMPT Organizations that are Members there are personal physical therapists. The meeting involved a lot of discussion about pre-manipulative screening in the cervical spine and as a result of the meeting the IFOMPT Standards Committee was asked to take the key issues forward. At the request of the Standards Committee an examination of a a pre-manipulative screening questionnaire (DR/LC) was developed. The questionnaire was sent in late 2007 to all IFOMPT Member Organizations and Registered Interest Groups (RIGs). the discussion meeting was organized in Rotterdam (AR) and facilitated by a development team (DR/LC/TF/WH/RK) including an expert selected from each MO. The meeting concluded that there is a need for an agreed international framework to inform the role of OMT in this area.

Key findings from the 2007 survey[1]

Twenty member organizations (100%) and 2 RIGs responded. MO membership varied between 7 small (≤100), 8 medium (101-399) and 5 large (≥400) countries. 7 member organizations (35%) have their own guidelines or protocols, 10 member organizations (50%) and 1 RIG mainly use them Another country (9 affiliates reported using affiliates from Australia and 1 affiliate reported using affiliates from the UK). Consequently, the majority of member organizations (85%) used both the pre-manipulation guidelines and the internationally accepted Australian guidelines. Only 5 (25%) member organizations There is a patient information sheet about cervical spine procedures and their risks. Eight member organizations (40%) and one RIG recommended warning patients of a small risk of stroke and death, while 3 member organizations recommended only informing about re-stroke. Therefore, to re-provide the information Serious adverse reactions are not standard practice in all countries. In their country, only 3 member organizations are aware of stroke cases attributed to manipulative physiotherapists.

For the patient’s physical examination, 17 member organizations (85%) and 2 RIGs taught the screening postural test involving extension and rotation (2 used rotation only), and all 20 member organizations (100%) and 2 RIGs recommended Manipulating position using continuous pre-screening test. 15 member organizations and 1 RIG teach additional preoperative screening tests including: Craniovertebral Ligament Test (8), Dizziness Differentiation Test (2) and Hautant Test (2).

When exploring the use of manipulation in the cervical spine, 8 member organizations (40%) and 1 RIG reported that members had reduced their use of manipulation in the upper cervical spine over the past 10 years. 19 member organizations (95%) and 1 RIG continue to teach the upper cervical spine Taught upper cervical manipulation involving end-of-range rotation with 3 member organizations. Thirteen member organizations (65%) and 1 RIG indicated that the manipulation technique taught had been changed to limit the amount of rotation used for upper cervical techniques.

It is recognized that practices in some countries may have changed since the survey was conducted, but these data provide a useful overview to inform the content of this document.

Highlights from the Rotterdam Forum 2008

The Rotterdam Forum agreed on the need for an international framework and agreed on the following key points and guiding principles to inform the first draft of the consensus document:

  • Existing documents need to inform the development of the international framework. special;
      • Clinical Guidelines for the Management of Vertebrobasilar Insufficiency in the Management of Cervical Spinal Disorders[2].
      • Manipulation Association of Chartered Physiotherapists Use of Mild Cervical Muscles and Physiotherapy: fact sheet[3].
  • Key aspects of the framework detailed in the Introduction are included.
  • Consideration is given to incorporating a pre-modification stability test.
  • Consideration was given to include information on craniovertebral ligament testing.
  • Recommendations for informed consent should be sufficiently flexible for jurisdictions (to include all Member Organisations).
  • Including preferences for abusive behaviors.
  • An IFOMPT endorsed document must be:
    • reflective of best practice and research
    • flexible and simple in application
    • legally suitable to individual countries
    • supporting patient-centered clinical reasoning
    • informative but NOT written when used in clinical practice.


  1.  Carlesso L, Rivett D (2011). Manipulative practice in the cervical spine: a survey of IFOMPT member countries. Journal of Manual and Manipulative Therapy 19(2):66-70.
  2.  Rivett DA, Shirley D, Magarey M, et al (2006). Clinical Guidelines for Assessing Vertebrobasilar Insufficiency in the Management of Cervical Spine Disorders. Australian Physiotherapy Association: Melbourne.
  3.  Kerry R, Taylor AJ, Mitchell J, et al (2007). Manipulation Association of Chartered Physiotherapists, Cervical Arterial Dysfunction and Manipulative Physiotherapy: information document. Available at: http://www.macpweb.org/home/index.php?p=170

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