Chiropractic and Strokes

Before visiting an upper cervical chiropractic specialist (or any other health professional), it is normal to do research online about the training, costs and associated risks with any type of treatment. When searching online, occasionally a topic comes up in the media around Chiropractic, strokes. Find out if this is true and the risks associated with care

 

Does Chiropractic Cause Strokes? The main connection made to Chiropractic and strokes is due to the theory that by performing adjustments this can have a direct negative effect on the arteries of the neck, specifically the vertebral arteries supplying blood to the brain.
However, there is no proof or valid research for this claim. Research instead suggests that normal range of motion of the neck actually puts more stress on the arteries than any adjustment (referred to in the research as CSM – cervical spinal manipulation).
Research has shown “no significant changes in blood flow†during these procedures. CSM was found, by a 2015 study (Buzatti), to not endanger the spinal cord or vertebral arteries any more than active rotation of the head (as would be performed by the patient themselves).  

 

What do the Statistics Say? Statistical risk of injury following Chiropractic care is approximately 1 in 5,000,000. This is far safer compared to drug poisoning (1 in 61,311) or other medical procedures (I recently learnt the chance of death by liver biopsy – testing, not treating a liver tumour – is 1 in 500!). Statistically, in term of its safety, Chiropractic falls between a Cataclysmic storm (1 in 2,467,570 chance) and being bitten by a dog (1 in 9,047,755 chance) for mortality. Back to strokes, the chance that somebody may have a spontaneous vertebral artery dissection (which some theorise can be caused by adjustments, despite the research) is 1/100,000 and the chance the carotid artery will spontaneously dissect (the other major arteries in the neck) is 1/50,000.
Statistically, this means that a carotid artery is 100 times more likely to dissect on its own without any intervention from a Chiropractor or other health professional, why?
This is due to the other risks factors associated with the condition, such as cardiovascular conditions. However, the literature shows that most are idiopathic, meaning there was no known injury or pathology but they still happened due to unforeseen reasons. The cases that this statistic of 1 in 5,000,000 are based on include cases where they believe Chiropractic intervention to have been a cause, however when the study is read further it is clear that the intervention called “Chiropractic Manipulation†was not always performed by a Chiropractor in these cases. When it was it was always after an incomplete and poor history by the practitioner to reduce red flags and pick up the symptoms suggesting the person was already having a stroke when they presented to their clinic!  

 

So What Causes the Strokes? The Cassidy Study in 2008 covered 109 million-person years of observation for vertebrobasilar injuries and strokes for patients entering Medical Doctor’s offices, finding the same incidence as for Chiropractors; suggesting the stroke was due to risk factors in the person’s health not the action of the physician.
Unfortunately for these people it would be clear that they were already having a stroke when entering the Chiropractors office, but the practitioner failed to ask them the necessary questions or do the tests need to rule out this diagnosis.
For both the Medical Doctor and Chiropractor it is unfortunate that somebody presents to them with the same condition which could be misconstrued as a simple headache or neck problem, yet both are a stroke.
For both cases this does not mean the adjustment or pain killer caused the stroke, it’s a sad case of wrong place wrong time.
In 2016, a study from Penn State Hershey Medical Center and Johns Hopkins University School of Medicine determined there was “no convincing evidence to support a causal link between chiropractic manipulation and CAD (cervical artery disease)â€.  

 

The Future Going forward, patients should feel comforted that we have no evidence of strokes being caused by Chiropractic techniques, with Chiropractic care being one of the safest treatments available with one of the highest patient satisfaction rates. For Chiropractors they must ensure to perform a thorough and detailed case history, physical assessment and nervous system tests to screen out any potential strokes for the safety of their patients. By remaining cautious and referring to other colleagues (such as cardiologists) when a stroke is suspected, we can give patients the best outcomes and prevent further harm. At our chiropractic centre in Singapore we have experience with patients who have previously suffered from strokes, helping the restore health to their nervous systems, facilitating improved healing while they go through this difficult stage.   Since 2013, Upper Cervical Chiropractor, Dr. Shaan Rai helped patients achieve greater health, relocating to Singapore in 2016 and founding Vitality Chiropractic Centres. He has an impressive track record in providing relief and solutions for people who experience nerve system problems, such as headaches, migraines, dizziness, vertigo or neurological conditions. Take your life back. For a Complimentary, no-obligation call with the Doctor or to book a Consultation, call +65 8438 9550 or email help@vitalitychiropracticcentres.com to find out if we can help you at our Chiropractic Clinic in Singapore.   ***a thank you to https://chiropracticronin.health.blog/2019/07/03/protopathic-bias-and-the-different-strokes/ for compiling the resources also contained in this article***

 

REFERENCES: Piper, Howarth, Triano, Herzog Quantifying strain in the vertebral artery with simultaneous motion analysis of the head and neck: A preliminary investigation.  Clinical Biomechanics 29 (2014) 1099–1107 Symons B, Herzog W. Cervical artery dissection: a biomechanical perspective. J Can Chiropr Assoc. 2013 Dec;57(4):276–8. Herzog W, Tang C, Leonard T. Internal Carotid Artery Strains During High-Speed, Low-Amplitude Spinal Manipulations of the Neck. J Manipulative Physiol Ther. 2012 Nov 6. Herzog W, Leonard TR, Symons B, Tang C, Wuest S. Vertebral artery strains during high-speed, low amplitude cervical spinal manipulation. J Electromyogr Kinesiol. 2012 Apr 5. Symons B, Wuest S, Leonard T, Herzog W. Biomechanical characterization of cervical spinal manipulation in living subjects and cadavers. J Electromyogr Kinesiol. 2012 Mar 6. Herzog W. Response to letter to editor by Drs. Haynes and Vincent. J Electromyogr Kinesiol. 2012;22(6):1018. Wuest S, Symons B, Leonard T, Herzog W. Preliminary report: biomechanics of vertebral artery segments C1-C6 during cervical spinal manipulation. J Manipulative Physiol Ther. 2010 May;33(4):273–8. Austin N, DiFrancesco LM, Herzog W. Microstructural damage in arterial tissue exposed to repeated tensile strains. J Manipulative Physiol Ther. 2010 Jan;33(1):14–9. Symons BP, Leonard T, Herzog W. Internal forces sustained by the vertebral artery during spinal manipulative therapy. J Manipulative Physiol Ther. 2002 Oct;25(8):504–10.  Quesnelle, Triano, Noseworthy, and Wells. Changes in Vertebral Artery Blood Flow Following Various Head Positions and Cervical Spine Manipulation. JMPT 2014, 37(1), 22-30 Buzzatti, Provyn, Van Roy, and Cattrysse. Atlanto-Axial facet displacement during rotational high-velocity low amplitude thrust: An in vitro 3D kinematic Analysis. Musculoskeletal Science and Practice. December 2015, Volume 20, Issue 6, pages 783-789. Newman-Toker DE, Moy E, Valente E, Coffey R, Hines AL. Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample. Diagnosis. 2014;1(2). Lee, Brown, Mandrekar, Mokri. Incidence and outcome of cervical artery dissection A population-based study. Neurology (67) 2006. 1809-1812 Fukahara, Ogata, Ouma, Tsugawa, Matsumoto, Abe, Higashi, Inoue, Tsuboi. Impact of initial symptom for accurate diagnosis of vertebral artery dissection. World Stroke Organization 2015, (10) 30-33 Kawchuk GN, Jhangri GS, Hurwitz EL, Wynd S, Haldeman S, Hill MD. The relation between the spatial distribution of vertebral artery compromise and exposure to cervical manipulation. J Neurol. 2008 Mar;255(3):371–7. Wynd S, Anderson T, Kawchuk GN. Effect of cervical spine manipulation on a pre-existing vascular lesion within the canine vertebral artery. Cerebrovasc Dis. 2008;26(3):304–9. Kawchuk GN, Wynd S, Anderson T. Defining the effect of cervical manipulation on vertebral artery integrity: establishment of an animal model. J Manipulative Physiol Ther. 2004 Nov-Dec;27(9):539–46.  Mattox R, Smith LW, Kettner NW. Recognition of Spontaneous Vertebral Artery Dissection Preempting Spinal Manipulative Therapy: A Patient Presenting With Neck Pain and Headache for Chiropractic Care. J Chiropr Med.; 2014 Jun;13(2):90–5. Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine. 2008 Feb 15;33(4 Suppl): S176–83. Church, Seig, Zalatimo, Hussain, Clantz, and Harbaugh. Systematic review and Meta-Analysis of chiropractic care and cervical artery dissection: No Evidence for Causation. 2016 Cureus 8(2): e498https://www.iii.org/fact-statistic/facts-statistics-mortality-risk
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