A valid pre-manipulative screening tool is needed.

The Australian Physiotherapy Association's Clinical Guidelines for Pre-Manipulative Procedures for the Cervical Spine represent a positive step towards the goal of reducing the incidence of vertebrobasilar strokes following neck manipulation. Nevertheless, the predictive value of the guidelines is largely contingent upon the validity of the physical screening tests, particularly sustained end-range cervical rotation. The primary issue is the sensitivity of the tests for detecting patients with vertebral artery occlusion and vertebrobasilar insufficiency, and who are at high risk of experiencing significant forces during manipulation which could result in intimal dissection.