Letters To The Editor

Letters to the Editor will be published, if suitable, as space permits. They should not exceed 1,000 words (typed double space) in length, and may be subject to editing or abridgement. Neck Manipulation as a Cause of Stroke To the Editor: I read with Interest your editorial on '"Neck manipulation as a cause of stroke*' ' in your Jan/Feb Volume 12, Number 1,1981 issue. Using the concepts devised and developed by Cyriax, we examine very carefully any individual whose neck is about to be manipu-lated after a thorough history to rule out such differential problems as blood dyscrasias, anticoagulant tlwrapy and signs of neuro-logical deficit involving the upper extremity or cord signs.1 People who have neurological deficit involving the upper extremity; that is, radicular pain plus neurological deficits of a motor, sensory, or reflex nature, are not suitable for manipulation. A careful history is taken looking for "drop attacks " indicative of instability of the atlas on the axis as is any other history suggesting vertebral artery insufficiency. These patients are not manipulated by the Cyriax routine. If none of these symptoms are reported, trac-tion manipulations are carried out in the neutral position. We never do flexion manipulations and we always manipulate the neck with traction, which exerts a centripetal force on thediscal material caus-ing it to move centrally. Yours sincerely