• VBI tests inappropriate to test blood supply
• Tests are not sufficiently sensitive: provide a false sense of security
• Solid anamnesis more important than tests

Manual therapists can suffice with a solid anamnesis to identify patients with an increased risk of complications after cervical manipulations. Diagnostic tests for vertebrobasilar insufficiency are not reliable enough to determine a distorted blood supply in the cervical arteries. Therefore, they can give the incorrect impression the therapist can manipulate safely. The authors of this article advise against the use of vertebrobasilar insufficiency tests.