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Suspect a patient at VBI? You might recommend it | Modern Manual Therapy Blog

Suspect a patient at VBI? You could recommend it -

The likelihood of a patient arriving at your outpatient physiotherapy practice with symptoms associated with vertebrobasilar insufficiency (BBI) is very, very, very minimal. BVI is an important diagnosis to consider, as many symptoms can mimic the benign peripheral etiologies of our industry.

Most of the data in the physiotherapy world on the incidence of IBD comes from manipulation, which ranges from 1 in 20,000 to 1 in 1 million. But I’m not talking about iatrogenic causes, but real spontaneous events, which would probably lead someone to walk into your office.

The likelihood of this non-benign condition is higher if you are treating neck pain and even higher if you are treating headaches and dizziness. We know that Lucy Thomas’ work in particular has shown in graphics reviews that dizziness, headaches, and balance / postural issues are high impact symptoms of IBD. His recent work confirmed previous work by Alan Taylor and Roger Kerry from the mid-2000s.

As differential diagnostic machines, we must be able to effectively treat neuromusculoskeletal diseases. Clinicians should always have the VBI as a little nugget on the back of the head because, frankly, a central cause of headache, neck pain, or dizziness is not one that we should step back slightly. in our knowledge of differential diagnosis.

cervical vertigo, cervicogenic vertigo, manual therapy, cervical spine
All rights reserved: Harrison N. Vaughan, DPT, FAAOMPT

We have written in the past (here, here, and here) on the exclusion of vascular sources that have led to these symptoms in the past and even wrote about the use of HINTS Exam to help clinicians differentiate between central and peripheral causes of dizziness. There has been a significant spike in power behind just looking at blood pressure and we know these tools are very necessary before doing any kind of mechanical testing, such as the VBI test.

Another tool that we don’t talk much about, but that we have in our algorithm to exclude spontaneous disorders, it is the use of biomarkers. The use of biomarkers for differential diagnosis is used for other conditions (such as the temperature of a fever) but they are not talked about much in the world of physiotherapy.

The use of blood biomarkers for the VBI differential was discussed over 20 years ago, but in my reading of the literature over the past decade, I haven’t seen much of it so far. . A recent study in 2020 outside South Korea by Sohn et al brought this information to life and want to share it with all of you.

The authors examined blood biomarkers to examine the differential diagnosis in 2 groups – 1 is central vertigo (CV) and 2 is peripheral vertigo (PV). We know VBI would be in central vertigo. The patient also underwent a comprehensive neurological exam, including an MRA and CT scan.

Here’s what they found:

Serum NSE and S100β levels are significantly higher in patients with CV, as occurs with posterior ischemic stroke or vertebrobasilar insufficiency. S100β and NSE can serve as serum biomarkers to differentiate CV and PV in patients with acute vertigo.

Take points home

Firstly, I take this information as another recommendation I could make to medical staff to get, in addition to a complete neuro exam, including MRA, if I suspect central vertigo during my physical examination.

Second, I take this information as another non-mechanical test (as before the ROM and VBI cervical test) that could be done before putting excessive stress on the blood vessels which could lead to spontaneous dissection to complete dissection. We all know how usual it is to happen and what has given manipulation such a bad name in the past. We had a great article that we wrote a while ago on what does NOT happen through manipulation, but of cupping and massage. I think it can help you understand this concept better.

Third, I know that we cannot order or have the ability to obtain blood biomarkers, nor understand how to read results professionally. Therefore, I am taking this type of study as a physiotherapist to confirm the already established optimal sequence algorithm to diagnose not only cervicogenic dizziness but also cervical artery dysfunction.

You can learn more about the cervicogenic vertigo screening and treatment process through Integrative clinical concepts, where the author and his wife, a vestibular specialist, give a 2-day course. Regarding this blog post, day one provides a review of the most up-to-date evidence from multiple disciplines to be diagnosed via the ‘optimal sequence algorithm’ to help rule out disorders and adjudicate in the cervical spine, including the determination of a single or double entity exists.

If you would like to organize a course for your staff (vestibular, neuro, athletic or ortho clinic), please do not hesitate to contact me at for prices and discounts.

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Harrison N. Vaughan, PT, DPT, OCS, Dip. Osteopracic, FAAOMPT

Instructor: Cervicogenic vertigo for integrative clinical concepts

Danielle N. Vaughan, PT, DPT, vestibular specialist

Instructor: Cervicogenic vertigo for integrative clinical concepts

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