Position: CHIROPRACTIC ADJUSTMENTS DO NOT RESULT IN STROKE WHEN IMPROPERLY APPLIED
Introduction: 1st argument
In the past years, case reports have been identified of patients with an experience of both chiropractic adjustments and stroke. This has led to a wide skepticism on the use of chiropractic adjustments in treating spinal problems such as neck and back pain [1].
While there is no doubt of the occurrence of each, stroke and chiropractic adjustments may just have a mere temporal relationship, wherein one does not necessarily and, most importantly, not always follow each other. The study by Smith and his colleagues in 2003 showed that “Spinal Manipulative Therapy (SMT) is independently associated with vertebral arterial dissection, even after controlling for neck pain” [5]. It is believed that the relationship was mainly because of the fact that more patients were more likely to undergo SMT within the days preceding stroke since neck pain and headache can be one of the symptoms of stroke [5]. So prevalent was the coincidence of episodes that doctors are advised to check for presence of stroke symptoms before doing the therapy.
Body: 2nd argument
Aside from the indirect and individual relationship, it has been proven that the incidence of stroke and neck manipulation were generally rare and therefore insignificant. Rothwell et al. in 2001, in their study of chiropractic manipulation and stroke showed that risk for serious adverse events such as cerebrovascular accidents can go from 1 in 400,000 to 1 in 3.85 million [4]. It is safe to assume, thus, that the incidence of stroke is generally less than the statistic stated. Another was a 10-year retrospective cohort study in Denmark wherein a recorded five cases of cerebrovascular accident and one death from the same were reported [3]. The studies, however, was not able to identify any specific risk factors in the study population that might be associated with development of vertebrobasilar artery dissection after chiropractic manipulation. Thus, everyone who has undergone manipulation is at risk.
Conclusion: 3rd argument
It should also be noted that chiropractic adjustments are delicate proceedings done by professional and well-trained chiropractors. Most of the studies failed to and cannot identify if such treatment was done by a professional or an untrained therapist [2] and therefore can be a source of prejudice to any study. While the risk of the spinal manipulation was evaluated, the certainty of the results will be very difficult to assess due to this bias presented by the skill and quality of the chiropractor. With or without identified relation and risk, professionals should be made aware of the probability of such an event happening to prevent them somehow.
Summation
The relation of stroke with spinal manipulation is partly because stroke symptoms include neck and head pain, which are one of the reasons why patients undergone manipulation. Failure to see this in a patient and manifestation of the event is the responsibility of the doctor primarily. Rarity of the event may demonstrate safety of such a therapy however no identified risk factors opens everyone to the prevalence of stroke. Lastly, one must be sure that a well-trained chiropractor is the one administering therapy for fewer chances of serious adverse events. Still, even if this was claimed, no data of how low are the chances of the occurrence for skilled professionals versus untrained ones.
References:
- Ernst E. Chiropractic Care: Attempting a Risk–Benefit Analysis. Am J Public Health. 2002 October;92(10): 1603–1604.
- Ernst E. Adverse effects of spinal manipulation: a systematic review. J R Soc Med. 2007 July; 100(7):330-338.
- Meeker WC, Haldeman S. Chiropractic: A Profession at the Crossroadsof Mainstream and Alternative Medicine. Ann Intern Med. 2002 Feb 5; 136 (3): 216–227.
- Rothwell DM, Bondy SJ, Williams I. Chiropractic Manipulation and Stroke: A Population-Based Case-Control Study. Stroke. 2001 Feb 21; 32: 1054-1060.
- Smith WS, Johnston SC, Skalabrin EJ, Weaver M, Azari P, Albers GW, Gress DR. Spinal manipulative therapy is an independent risk factor for vertebral artery dissection. Neurology. 2003 May 13;60(9):1424-1428.
