Extension Rotation Test | Vertebrobasilar Insufficiency (VBI)

[@darrennoriel5693]

You guys are basically getting me through my licensing exam

[@Physiotutors]

Nice, that's our goal!

[@MadeInJamdung]

I am an American osteopathic medical student and I find your videos incredibly helpful. I refer to them constantly.

[@philippeverhagen2725]

@ Badplus : I read the article you mentioned. It is exactly what physiotutors said: When you rotate to the left: the blood flow to contralateral side is significantly decreased, and the other way round. So : This means you are in fact testing the same side of the rotation, because if the blood flow to this side would also be compromised, then the symptoms would occur (so both sides will be showing less bloodflow). Too bad the used "healthy" subjects and not patients with VBI symptoms. That said however, I agree with the fact that such a degree of extension and rotation could be in fact more dangerous then a HVLA manipulation with no extension. That is why we never manipulate the cervical spine in extension. @ Physiotutors : In my humble opinion, this test should be performed in sitting position and the patient should be asked to actively but carefully extend and rotate the head and then count (similar to the Hautant's test ) He or she will immediately feel symptoms and thus will immediately stop extending or rotating too much. So no passive testing , not even sub maximal. In taking a thorough anamnesis they would probably have mentioned dizziness while looking up/rotating anyway. In my opinion , performing this test passively could be more harmful then gentle HVLA manipulation in 0 extension. Just some thoughts from an osteopath who treats patients with dizziness on a daily basis.

[@Physiotutors]

Agree with what you say Philippe. The test is also not sensitive enough to pick out patients who really have VBI, so we personally find it hard to find a good use for it in practice. As soon as you expect VBI from patient-history, you'd refer directly. The IFOMPT document is currently being updated and as far as we know there will be a lot of changes concering the screening procedure.

[@PhysioAl1]

Great content mates

[@mikechapman1992]

Your videos are fantastic 👌 love the associated neuroanatomy with the signs and symptoms chart.

[@mhawyma]

Thank you so so much we are appreciate what you are doing to teach us 🙏

[@Physiotutors]

Thanks and you're welcome :)

[@spflyer2009]

covered what i needed thank you! very good explanation

[@quratulainkk]

If symptoms appear during rotation to right it means there is an insufficiency of left artery?

[@reshmasaldanha5087]

Hello! I just happened to see VBI video & was quite informative. I have recently diagnosed VBI. My symptoms are Headache, Dizziness & Vomiting non stop. First episode happened in jan 2020 with course of medication, rest & 15 sittings of Physio. Now again same episode happened from yesterday. Could you please advise what should be the next course of action. Thank you.

[@lordzmusic8461]

What treatments are you taking??? Please say me ..... Do u get constant dizziness and double vision also occurs??

[@OurAshX]

How are you now

[@jagmalsingh3679]

Hello sir I want to know is full neck rotation is harmful and if yes plz tell it’s faults and disadvantages of it

[@akshunkhajuria9985]

I had very bad headache after doing this test. Is it normal? Please reply.

[@TimUlzheimer]

How it is with the Hautand Hang probe?

[@sadmanrahman2129]

Is hair loss a symptom of VBI ?

[@forteroche]

Hi Guys!!! you are doing a great job...If you don't mind me asking,which uni did you guys graduate from as I would like to study there based on the knowledge you have put out...Thanks :)

[@Physiotutors]

We did our bachelors at the European school of physiotherapy and our masters at SOMT University of Physiotherapy

[@sasankamahanta7090]

Please upload videos about vaious techniques of Muscles stretching..... Please.....

[@Physiotutors]

Not our primary focus to be honest as stretching has low evidence and is usually just a short-term pain reliever.

[@sasankamahanta7090]

Ok

[@loveconquersall143]

If you moved your head right back (like I did) and you have a drop attack, would that be indicative of vertebrobasilar insufficiency...?

[@Physiotutors]

Could be and maybe good to get it checked out.

[@sarahkremer3]

Is this test also known as Hautards test?

[@bloodflowrestrictiontraini2647]

Do you mean opposite side to the roataion symptomatic

[@Physiotutors]

Opposite side of rotation is occluded/narrowed. So u are testing the site of the rotation regarding it's capacity to compensate for the decreased blood supply to the hindbrain

[@bisoffi91]

grasias!

[@BraySandy-h3j]

Cesar Shoal

[@worldssuccesslifeshailesh3731]

But sir very super

[@Physiotutors]

Thanks Shailesh!

[@badplus0176]

2:45 no, you’re not. You can stretch or compress either artery. The finding is not localizing. KZbin University at its best

[@Physiotutors]

If you look at the anatomy of the vertebral artery it makes sense that it is compressed with contralateral rotation, which is also mentioned in the description of the test. Can you elaborate on your comment or send us a link to articles backing your comment?

[@hannesc4875]

Check this article, I know however there is not a lot evidence on this contralateral topic but still... Mitchell JA. Changes in vertebral artery blood flow following normal rotation of the cervical spine. J Manipulative Physiol Ther. 2003 Jul-Aug;26(6):347-51. PubMed PMID: 12902962.

[@Kaydouble1]

You don’t examine the artery in this position anymore. Too risky. In this position only in cervical Flexion or sitting in cervical extension

[@badplus0176]

That’s a great way to dissect the vertebral artery! Why in the world would you ever hyperextend the neck and rotate the head manually when you think this could be a problem? If an osteophyte is causing a vertebral artery occlusion or compression, you may induce a stroke. Carry some good malpractice insurance, bro! 👍🏼

[@Physiotutors]

You don't dissect a vertebral artery by moving into submaximal rotation and extension. How many times do you think a patient does this movement on his own during activities of daily living? What the test assesses is the blood flow to the brain in a possibly already compromised vessel. If your suspicion of cervical artery dysfunction is already that high due to patient history, there is no need to do any additional tests as they are not sensitive (and only specific) anyways and you should directly refer out to a specialist.

[@alex8480]

You're pretty dumb. You've commented this on two videos that I've seen talking about VBI and are completely wrong.