SI-PL-1154

Monday 12:10, Palau de Congressos, Hall 5, Room 4

ALTERED HAEMODYNAMICS AS A NEW CONCEPT IN PHYSICAL THERAPY; SHOULD MANUAL THERAPY ASSESSMENT INCORPORATE SIMPLE CLINICAL VASCULAR TESTS? Taylor A, Kerry R; Nottingham Nuffield Hospital, Nottingham, United Kingdom. PURPOSE: Physical Therapy (PT) assessment takes into account biomechanical factors affecting the neuro-musculoskeletal system and more recently myofascial and visceral structures. Interestingly, very little attention has been paid to the vascular system and alterations in blood flow to limbs/structures or common sites of pain syndromes. The concept of altered haemodynamics whilst new to PT is widely accepted in medicine and relates to changes in blood flow as a result of intrinsic or extrinsic factors. This paper discusses the relevance applications of vascular assessment to PT practice. RELEVANCE: An increasing number of research and case studies in the medical literature relate to vascular syndromes affecting young patients. Much of that literature has been critical of manual therapists for the use of prolonged or unnecessary treatment leading to delays in diagnosis. Despite the fact that many PT techniques aim to alter blood flow to target structures there is very little in the literature relating to the vascular system or the mechanisms which affect it. It is proposed that increased knowledge of this system is integral to PT assessment and practice. DESCRIPTION:  The information which informed the principles of this paper was ascertained from extensive literature searching/analyses, clinical experience and previous research projects undertaken by the first author. OBSERVATIONS: PT literature pays little attention to haemodynamics outside of the vertebro-basilar and carotid structures. Many vascular syndromes have been documented in the medical literature. Injury, abnormal anatomy, positional factors and posture have all been hypothesised to affect or alter blood flow. Furthermore, perhaps due to changes in diet, lifestyle and activity levels, atherosclerosis and more recently endofibrosis is reported increasingly in younger individuals. A number of simple clinical tests have been accepted as valid clinical tools for assessment. However, simple pattern recognition of subjective pain behaviour and sites has been shown to be integral in assisting the alert clinician to the presence of a vascular component. As vascular conditions are commonly progressive and may become limb threatening the failure to recognise such conditions in a manual therapy environment may have serious sequelae for the patient and therapist alike.  CONCLUSION: Contrary to popular belief vascular conditions may affect young apparently low risk patients. The PT profession has traditionally only paid scant regard to this vital system. The authors believe that knowledge of haemodynamics and the ability to assess the vascular tree is integral to clinical reasoning and safe clinical practice. Physical Therapists can play an important role in recognising vascular syndromes at an early stage.