During a recent course, I was asked if manual cervical therapy (MCT) was contraindicated in the presence of a cervical syringomyelia.
What is it?
Syringomyelia is a condition characterised by a fluid-filled cyst (syrinx) within the spinal cord (Figure 1), which can influence cerebrospinal fluid dynamics. This cyst can lead to neurological symptoms such as pain, weakness, and sensory disturbances. Signs of the disorder tend to develop slowly, although a sudden onset may occur with Valsalva-like activities, such as coughing or straining.
Figure 1: Cervical Syringomyelia
Comorbid Conditions
Syringomyelia is most often associated with Chiari malformation, particularly Chiari type I, occurring in 20-50% of cases. Other comorbid conditions include spinal cord trauma, spinal cord tumours, and arachnoiditis.
Hands or Hands off?
When the syrinx is located in the cervical spine, the risks associated with MCT increase significantly. Therefore, the contemporary perspective on MCT for individuals with cervical syringomyelia is one of extreme caution.
The literature is guarded about whether MCT is contraindicated. Limited high-quality research specifically addresses manual therapy in the context of cervical syringomyelia. Most recommendations are based on clinical expertise and an understanding of the pathophysiology of syringomyelia. As always, the priority is to avoid harm, so MCT is approached with significant caution.
Manual cervical therapy, particularly techniques involving high-velocity thrust techniques or significant pressure, may exacerbate the condition by increasing cerebrospinal fluid pressure or causing mechanical irritation to the spinal cord. Therefore, syringomyelia (and Arnold-Chiari malformation) is often regarded as a relative or absolute contraindication for MCT.
However, MCT appropriateness can be determined individually after thoroughly evaluating clinical symptoms, physical examination results, and diagnostic imaging. If manual therapy is suitable, it should include only gentle, non-invasive techniques like passive accessory intervertebral movements and experienced in vivo symptom monitoring. Its presence has not influenced my outcomes with patients with comorbid syringomyelia and MCT.
Conclusion:
MCT is not considered a standard treatment for patients with cervical syringomyelia, but it can be considered under the guidance of a healthcare team familiar with the condition. The risks often outweigh the potential benefits, and any intervention must prioritise patient safety.
The information and perspectives shared here are based on my clinical experience and understanding of manual therapy in the context of syringomyelia and related conditions. This content is intended for educational purposes only and should not be interpreted as specific clinical advice or recommendations for individual patient care. Each patient’s situation is unique, and healthcare professionals must rely on their clinical judgment, training, and the specific circumstances of their patients when making treatment decisions. For any concerns or questions regarding patient care, it is essential to consult with a qualified healthcare professional or specialist.
