When performing orthopedic manual therapy (OMT) on the cervical spine, safety checks arenecessary. In this paper we provide an overview of the risks and their evaluation of the cervical vascularsystem, focusing on the IFOMPT framework published in 2020. Although adverse events after OMT onthe cervical spine are rare, efforts to reduce the risk are necessary. The current hypothesis is that adverseevents related to cervical vasculature after OMT may have an underlying pathology that worsens withtreatment. Therefore, it is necessary to consider risk factors, symptoms, and signs to reduce the risk. Onemajor change in the framework is the exclusion of the cervical positioning test because of its low sensitivityand difficulty in predicting adverse events. It is important to fully understand this framework as it providesimportant information for physical therapists to evaluate and manage patients with potential vascular lesionsand develop appropriate clinical reasoning.

Integrity tests have been commonly used to evaluate the integrity of ligaments in the head andneck region. In recent years, however, several problems with the implementation of these tests have becomeapparent. The most significant problem is that many of these tests have high specificity but low sensitivity.Low sensitivity means that they are inadequate as indicators of safety screening prior to manual physicaltherapy. This paper discusses the significance of the stability tests in the evaluation of instability in thehead and neck region and the pros and cons of their implementation, with a discussion of the literature.

This paper summarizes cervical spine treatment accident and adverse event reports. Deathswere reported after chiropractor interventions, which were described as being due to vascular problems.Regarding adverse events, mild adverse events occurred in 0–30% of cases after cervical spine treatment.However, this rate is not notably higher than those of other treatments. In cervical spine approaches,insufficiency of blood flow in the vertebral artery has been focused on as a risk factor, but in recentyears, vascular dissection has become the highest risk factor. For safe cervical spine treatment, a correctassessment based on clinical reasoning is important.

[Objective] To perform treatment using mechanical diagnosis and therapy (MDT) for patients withlumbar spondylolysis during the growth stage and to confirm the trend. [Subjects and Methods] After adiagnosis of lumbar spondylolysis, 33 adolescent patients (28 males, 5 females, mean age 14.3 ± 1.9 years)who consented to the treatment plan using MDT were treated. Low-intensity pulsed ultrasound therapy wasalso performed for 3 months (1/week). [Results] In MDT, directional preference (DP) was observed in allof the patients, and they were classified as derangement that can be reduced. Low back pain and lumbarrange of motion improved quickly, and they resumed sports after an average of 17.5 ± 6.7 days. [Conclusion]As a result of using MDT for adolescent patients with lumbar spondylolysis during the growth stage, allpatients were found to have DP and were classified as derangement that can be reduced, and the treatmentprogressed well. Our experience with MDT indicates new possibilities for the future treatment of low backpain during the growth stage of adolescent lumbar spondylolysis patients.

The Person-Centered Therapeutic Relationship in Physiotherapy Scale (PCTR-PT) is a patientreported outcome measure that assesses whether patient-centered physiotherapy is being provided, and has adequate psychometric properties. The purpose of this study was the cross-cultural adaptation of the PCTRPT into Japanese, following Beaton’s international guidelines for cross-cultural adaptation of questionnaires through five stages: (1) forward translation, (2) forward translation integrated version creation, (3) back translation, (4) provisional Japanese version creation, and (5) pilot test. In the pilot test, 30 Japanese participants with musculoskeletal disorders rated their understanding of each statement in Japanese on a 5-point scale (from 1: not understandable at all in Japanese, to 5: sufficiently understandable in Japanese), and comments were obtained on the passages that received a score of 1 to 3. Based on the comments, the final Japanese version of the PCTR-PT was developed through discussions held among all translators and authors. Revisions and pilot tests were repeated until a score of 4 or higher was obtained for 90% or more of all items.