Without a doubt, the modern world we live in has more than a few aspects which contribute to chronic pain and illness.
I discuss those aspects frequently at this blog, but in short there are things like stress, poor nutrition, infrequent exercise, lack of sleep, bad posture, etc. all of which add up to make our bodies scream at us in protest.
So, when we look for solutions to these ailments, oftentimes the course of action involves taking a pill, or at least getting the advice of the family doctor. While the answer may or may not involve correcting the maladaptive behavior which caused the issue in the first place, the end-result is usually a reliance on fairly conventional medical practices to figure out and solve the problem.
Of course, there are those who buck convention and turn to alternative or less mainstream solutions to their wellness issues. In recent years, health solutions like chiropractic and yoga have become increasingly popular. It’s hard to say what precisely has lead to this popularity, but a general distrust of the health industry and pharmaceutical companies probably has something to do with chiropractic’s popularity. American preoccupation with everything Asian, as well as dissatisfaction with the Globo-gym model of exercise has probably played a role in the proliferation of yoga centers.
And of course, I won’t discount the fact that people achieve some sort of benefit or success with these practices as well, as a reason for their popularity. From a holistic standpoint, some folks would just rather solve their problems without pills or treadmills, and I can get behind that.
But where my support falters is when the practices are not supported by evidence-based science, and where I jump off completely is when the practices can cause injury, without having proven benefits.
Now, in the case of chiropractic and yoga, I have no doubt that people experience some benefits from them. The manner and degree of these benefits is undoubtedly highly individual, but yoga can give you a great workout, and improve things like your balance, flexibility, and relax your breathing. And for chiropractic, people swear by it and report measurable decreases in pain or related symptoms.
But at some point, in a desire (not necessarily conscious) to increase the popularity of a particular system, people start attributing more and more health benefits to it. At the risk of sounding cynical, I must suggest that if a person’s income depends on the popularity and utility of a practice, finding more ways to market that practice is highly lucrative.
This holds true for alternative health systems just as much as it does to the pharmaceutical industry. See how more and more conditions are labeled as diseases nowadays, thus providing the opportunity to market a pill to solve it. Claims that subluxations in your spine are the root of most ailments, or that yoga can fix things ranging from easing menstrual cramps to alleviating asthma, are nice but reveal an inherent intent to extend influence.
You don’t need to do a headstand in order to work on deep breathing, and in so doing improve your asthma condition.
So, do chiropractic manipulations and yoga exercises really have the potential to cause strokes?
Yes. The probability of it occurring might be fairly low, depending on individual susceptibility, but the increasing popularity of both practices, leading to the increased incidence of improper application, means there is an increased probability of incidence. In the case of chiropractic, estimates have varied from one in ten million manipulations to one in 40,000. [1]
The mechanism by which chiropractic and yoga can cause strokes almost entirely involves the neck, or cervical spine. So, if you avoid doing anything that involves those areas, you can probably reduce your stroke risk from yoga and chiropractic to almost nil.
What happens is, that a sudden and sharp manipulation of the cervical spine by a chiropractor, or an extremely high degree angle turn of the neck in a yoga inversion like a headstand, can cause a cervical arterial dissection leading to ischemic stroke.
In simpler terms, damage is done to the arteries in the neck either by sharp angles or rapid twisting, leading to clots which can immediately or later dislodge and travel into the brain. These clots block blood flow leading to brain tissue damage.
This inherent weakness in the neck is present because two vertebral arteries run straight up the back of the neck passing through holes in the sides of each neck vertebra. As the neck twists, so do these arteries.
I don’t utilize the services of chiropractors, but if I did, after learning about this I would tell tell him or her to never go near my neck. I would hate to end up like some of the young healthy people who have literally had strokes while lying on the table in the chiropractor’s office. [2]
It’s even more unfortunate that tragic events like what happened to Ms. Mathiason (previous link) were not acted upon more appropriatedly afterward, and with more emphasis by the governing organizations on safety and efficacious practices. [3] Instead the modus operandi is to relegate the unfortunate circumstances to “a statistic”.
With yoga, there is a similar situation. The author of a recent NY Times article [4] and an upcoming book The Science of Yoga, has laid out the case that extreme yoga positions, those which involve stretching the cervical spine past what is generally considered the normal physiological limit of flexion, are the cause behind various nerve and arterial injuries, some of which could have been the cause of strokes. [5]
Like the incidents involving chiropractic, all of the recent attention on this matter has invoked a wave of backlash from proponents of yoga suggesting that these are just “statistical anomalies” and that the benefits far outweigh the risks. But, do they though? Is it worth it to strain and try to perfect a headstand, just to achieve some bragging rights or some health or fitness benefit which may or may not be backed by actual evidence?
Keep in mind that yoga is just a convention, it’s not based on natural movements, as if there is any kind of behavioral or evolutionary-adaptive reason to stand on your head. Just because something gives you a good workout does not automatically mean it is appropriate, safe, natural, or functional. The physiological limits of the human neck’s range of motion demonstrate well enough the dangers of not recognizing this point.
***
In the case of chiropractic, I feel that it is not advisable to have your neck manipulated to alleviate your headaches, when it is not clear that spinal manipulations are efficacious in this regard [6,7,8]. When we know more about the physiological mechanism by which a procedure causes harm, than why it causes benefit, red flags should go up. Sure, more conventional remedies like aspirin have their own side-effects, but we understand and have documented the physiological process by which aspirin works. You might have some good results with a chiropractor for lower back pain, just have them stay away from your neck.
As for yoga, I think it has a lot of great aspects to it, but ego, poor physical conditioning, inexperience, and an unquestioned belief that yoga is completely safe in all regards is a recipe for injury. People are chasing after rewards that they think they can only get from yoga, when there are plenty of safer ways to train breathing and flexibility. At the least, there needs to be more discussion about the kinds of injuries and chronic issues that higher-level yogi’s are experiencing [9], and an honest concession that inadequate or improper training of yoga can be dangerous.
People look at weight lifting and recognize that if you do things wrong you can really hurt yourself, but I think most people look at yoga like it is harmless. Maybe difficult, sure, but they’re thinking the worst they could do is strain or pull a muscle. It seems rarely considered that putting your body in all kinds of unnatural positions might be putting unreasonable strain on your joints or vascular tissues. Be mindful of the relative fragility of your neck, and consider avoiding yoga positions which put undue stress upon it.
Regardless of the statistical chance of mishap, I feel that it is important to be able to demonstrate with causal evidence that a particular practice provides the intended benefit, before considering that the risk of death or severe injury is unimportant. Examples of dangerous injury need to be trumpeted most loudly by practitioners, rather than downplayed and buried with statistics. If a practice has merit, increasing awareness of dangers will not hurt popularity, since it will make it safer for more people to participate.
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31 Responses to What do Chiropractic and Yoga Have in Common? Potential Strokes Caused by Neck Injury
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As a Chiropractor focusing strictly on nutrition in my practice, I would like to address that the chances of a stroke from a chiropractic visit are statistically equal to the chances of a stroke from a primary care doctor visit.
Additionally the same stats would apply to anyone of high risk who happened to be star-gazing, having sex, engaging in certain yoga positions, or spending time at the salon where their hair was washed in one of those sinks that you extend your head into.
A person with an impending stroke is likely to have neck pain, dizziness etc, that brings them into the medical doctor’s or chiropractor’s office in the first place.
They have their stroke and the office visit was just a matter of temporal association.
This does not negate chiropractors from all responsibility, in the big cases that have been publicized (which are still very few when you look at the number of adjustments rendered etc), the chiropractor made silly mistakes such as trying to adjust the same joint over and over again.
Or not appropriately referring a patient to the emergency room in the first place, disregarding risk factors such as smoking, hypertension, and they are handled by their boards just as other professional associations handle their bad eggs.
It does not mean the Chiropractor “caused” it, just as you could not necessarily say that the Primary Care Physician “caused” it.
Chiropractors are trained to minimize extension and rotation in their cervical adjustments and to tread carefully with any patient who may be at high risk (smokers, hypertension, past stroke, elderly, high degree of spinal degeneration, or demonstrate “red flags” (ex. dizziness, headache of severe nature, “worst headache i’ve ever had”, etc ). T
here are also other techniques that can be personalized to a patient that do not involve twisting and rapid turning or the chiropractor may focus on isolated muscle stretching techniques to help improve the biomechanics of the region.
“the chances of a stroke from a chiropractic visit are statistically equal to the chances of a stroke from a primary care doctor visit.”
That’s a pretty bold statement to make, a citation would be graciously appreciated.
I’m not aware of cervical manipulation, a known risk factor for vertebrobasilar artery dissection [1], being a common practice in normal primary care physician appointments, as opposed to general chiropractic visits which often involve spinal manipulation.
When a person collapses on the table after cervical manipulation, the probability of causation is pretty damn high. Of course, it’s possible the stroke still might have occurred though at a later time. I’d say later is better than sooner.
I’m also sure there are other methods of mechanical pain relief for the neck that don’t involve pills or stroke-related manipulations. Heat, massage, tincture of time, etc. [2]
http://www.ncbi.nlm.nih.gov/m/pubmed/18204390/
Pubmed article for you … Dr. Rhinehart is correct. More comprehensive letter to follow.
Thanks for tracking down the review article for me.
Alexander J. Rinehart, MS, DC, CCN´s last [type] ..A Simple 5-Minute Technique to Identify Why You and I Have Trouble Creating Healthy Habits and Motivating Change
My pleasure … So sorry I just realized that I spelled your name incorrectly. I am looking at your website and very interested … I am fairly new to the paleo lifestyle and have been interested in finding effective ways to incorporate into my practice … I will continue to search your site … All my best: Dr. Cardinal
From the full text of the Cassidy article:
“Our results should be interpreted cautiously and
placed into clinical perspective. We have not ruled out
neck manipulation as a potential cause of some VBA
strokes. On the other hand, it is unlikely to be a major
cause of these rare events. Our results suggest that the
association between chiropractic care and VBA stroke
found in previous studies is likely explained by presenting symptoms attributable to vertebral artery dissection.
It might also be possible that chiropractic manipulation,
or even simple range of motion examination by any practitioner, could result in a thromboembolic event in a
patient with a pre-existing vertebral dissection.”
If there is no proven benefit to a procedure, and the procedure can potentially cause harm, the procedure should not be administered.
So are you saying chiropractic has no proven benefits? Do I understand your statement correctly?
Dr. Cardinal
P.s. may I ask what you credentials are ?
No, you don’t understand me correctly.
I have written above that chiropractic has shown benefits for people suffering from conditions like lower back pain. Specifically saying, “You might have some good results with a chiropractor for lower back pain”
However, the available evidence is less clear (to me) on this matter for neck pain, based on the research I’ve reviewed on PubMed and Google Scholar.
I’m not sure how my credentials are important, unless you seek to discredit me via ad hominem. If the data are relevant in the published research, then that is what matters.
Regardless, the extent of my university education has always been disclosed at the bottom of this website.
http://www.ncbi.nlm.nih.gov/m/pubmed/21640251/
For your reference.
Was just curious as to what your background/education was … No intent to discredit you.
The article you wrote is very misleading for the lay person … it can insight fear rather than laying out the facts and letting the reader choose. No where in your article do you fully disclose the full Cassidy article or at least the main point … That the results need to be interpreted cautiously and taken into clinical perspective … That in essence seeing a chiropractor puts you at no more risk than seeing a primary care physician … That statement which you claimed to be bold … Yet the pubmed review concludes the such. Your article tells half truths and would make me scared if I did not know better. I am new to the paleo lifestyle and very excited about the changes I have made in my own life and look forward to bringing this to my patients … But it is discouraging to me to know that my profession will be presented in an inaccurate and bias fashion within this community … I am sure hopefully there are other paleo supporters that also recognize chiropractic as well in a
Positive light.
http://www.ncbi.nlm.nih.gov/m/pubmed/16949939/
Another pubmed review for your reference, regarding neck pain and chiropractic.
I do not represent a paleo community, I represent myself and my academic interests. The merits of chiropractic should not have to rely on supporters in order for them to come to light. If the evidence is there, it will surface.
I quoted the passage from the Cassidy article to point out that even the authors of the study recognize that their findings do not rule out neck manipulation as a potential cause of some VBA strokes. This is apparently left out of much of the pro-chiropractic discussion on the subject.
The study is interesting, and sheds further light on the subject, but one study is hardly conclusive. Yet you are convinced it has ended the debate?
Anybody can review the full text of that article simply by going to Google Scholar. That’s what I did. Here, simple: Spine 2008;33:S176–S18.
I’m skeptical of research published in the Journal of Manipulative and Phsyiological Therapeutics. It has a stated purposed of advancing chiropractic healthcare, leaving much potential for bias, yes? I prefer to sample research from a variety of journals.
The sampled research indicates that:
1. Spinal manipulation treatment alone is less effective than when strength training or rehabilitative exercise is incorporated.
2. Spinal manipulation is no more effective than exercise rehabilitative treatment for neck pain.
3. Intensive training of the cervical musculature, physiotherapy, and chiropractic treatment exhibit no clear advantage from each other.
4. Adverse reactions to chiropractic care for neck pain are common.
From this I conclude that there is no reason to choose cervical manipulation as a treatment for neck pain over other available treatments, and since it has an acknowledged association with adverse reactions, sometimes of a severe nature, regardless of causality it seems appropriate to choose a mode of treatment which presents less risks.
It should also be noted that this site itself is sponsored by multiple medical spinal surgery centers.
Which site? My blog? If there are ads on the right side for such things, I have no idea. It’s called Google Adsense, and I have little control over what appears there.
I’m probably going to shut those down anyway at the end of this month, since they barely generate enough money for me to feed myself.
David,
A friend of mine has been diagnosed with scoliosis and after 3 months of pain, heavy doses of nsaids and ineffective physiotherapy, 2 sessions of one to one yoga with a good teacher have made a big difference.
She said that the pain relief and feeling of well being after the sessions made her feel “high”.
No extreme positions were involved.
I’m trying to convince her that eliminating grains from her diet and minimizing sugar will also have positive effects.
What kind of exercise and lifestyle would you suggest that may help further?
Scoliosis and lordosis are quite common and under diagnosed. My friend has been diagnosed at 41 years. This should have been spotted and treated years ago.
Conventional medicine seem to advocate high doses of painkillers and eventually radical spinal surgery with poor results.
Bill, I can relate, my lovely wife was born with scoliosis but luckily it was watched for because her mother has it as well, so they were prepared. She wore a back brace through much of adolescence which seemed to prevent it from becoming more severe.
She regularly does core strengthening exercises. I feel this is incredibly important to maintain since your abdominal muscles support the trunk and provide postural support to the spine.
I’m not certain if abdominal and posture exercises will be enough to prevent the need for surgery, but one can hope.
Instead of hundreds of sit ups though, I would recommend exercises like weighted overheat squats. Here is a video explaining the technique: http://www.youtube.com/watch?v=PCWLs1jTOVE
I think the other doctors are too sensitive. My take away from your blog post is that chiropractic and yoga can work well for some people, but just be aware that there are certain things that are unnecessary and potentially harmful – twisting the neck unnaturally and standing on your head, for instance.
I do not think you were putting down Chiropractic or Yoga at all. Information and awareness is always a good thing.
FYI, my bff is an ER nurse, and she had a 30 year old woman die on her last year – the lady had been brought there from her chiropractor because she had a stroke after having her neck manipulated. She was otherwise perfectly healthy. I’ll go to a chiro for back pain but stay away from my neck!! I think about that woman often.
Steph, yes that was the main point of my article. Thank you. The story like what you shared is the reason I wrote this, it terrified me to learn that such things could happen to young and healthy people.
My best friend died from a having his cervical artery sheared during a neck manipulation. The neurologist who is the medical director for our sleep diagnosis company, upon hearing this, stated, “Chiropractors are like voodoo.” Chiropractic work may be effective for back issues but neck manipulation is barbaric.
I’m sorry to hear that Steven, that’s a terrible tragedy.
Compliments of Dan Murphy
Parachute use to prevent death and major trauma related to gravitational
challenge:
Systematic review of randomised controlled trials
British Medical Journal
December 2003, Volume 32, pp. 1459–61
Gordon C S Smith, Jill P Pell
FROM ABSTRACT
Objectives: To determine whether parachutes are effective in preventing major
trauma related to gravitational challenge.
Design: Systematic review of randomised controlled trials.
Data sources: Medline, Web of Science, Embase, and the Cochrane Library
databases; appropriate internet sites and citation lists.
Study selection: Studies showing the effects of using a parachute during free fall.
Main outcome measure: Death or major trauma, defined as an injury severity score
> 15.
Results: We were unable to identify any randomised controlled trials of parachute
intervention.
Conclusions: As with many interventions intended to prevent ill health, the
effectiveness of parachutes has not been subjected to rigorous evaluation by using
randomised controlled trials.
Advocates of evidence-based medicine have criticised the adoption of interventions
evaluated by using only observational data. We think that everyone might benefit if
the most radical protagonists of evidence based medicine organised and
participated in a double blind, randomised, placebo controlled, crossover trial of the
parachute.
THESE AUTHORS ALSO NOTE:
The parachute is used to reduce the risk of orthopaedic, head, and soft tissue
injury after gravitational challenge, typically in the context of jumping from an
aircraft.
“The perception that parachutes are a successful intervention is based largely
on anecdotal evidence.”
2
These authors undertook a systematic review of randomised controlled trials
of parachutes. They excluded studies that had no control group. The major
outcomes studied were death or major trauma. “Our search strategy did not find
any randomised controlled trials of the parachute.”
“It is a truth universally acknowledged that a medical intervention justified by
observational data must be in want of verification through a randomised controlled
trial.”
“Parachutes reduce the risk of injury after gravitational challenge, but their
effectiveness has not been proved with randomised controlled trials.”
We accept that common sense might be applied when considering the
potential risks and benefits of interventions.
“We feel assured that those who advocate evidence based medicine and
criticise use of interventions that lack an evidence base will not hesitate to
demonstrate their commitment by volunteering for a double blind, randomised,
placebo controlled, crossover trial.”
COMMENTS FROM DAN MURPHY
Every now and then I am asked if an opinion I express has been supported by
a double blind, randomized, placebo controlled clinical trial. The point of this
satirical article is that not everything can or needs be investigated with the holy
grail of assessment protocols. Sometimes, common sense must be used. It is
obvious that there are no double blind, randomized, placebo controlled clinical trials
of the effectiveness of parachutes.
Chiropractors and others often base their clinical protocols on anecdotal
evidence. As these authors note, “The perception that parachutes are a successful
intervention is based largely on anecdotal evidence
It’s an intriguing comparison, and your point is not lost on me for sure.
When people jump out of an airplane, they well know that their chute might not open and could die. That’s why skydiving is popular among thrill seekers.
However, one of the points of my article is that many people seemingly go to chiropractors or do yoga without understanding the potential risks, or the history of adverse events/reactions with their respective practice.
Let’s put it into perspective using the Aspirin example that you feel we know the physiological effect of: “The American Medical Association puts the death rate from aspirin-related products – when used as directed – as high as 30,000 people each year.” That is just taking it correctly, as the science has told us is appropriate. Not to mention the tens of thousands of hospitalizations as well. That makes chiropractic 3,333 times safer than taking an aspirin and who knows how much safer yoga would turn out to be.
Doctors have been prescribing aspirin to prevent heart attacks and stroke for years. The tragic irony of it all is that more and more research points to the fact that taking aspirin every day can actually increase the risk of heart attack or stroke in up to 40 percent of the population.
If truly the point or one of the points of your article is of informed consent and reducing unnecessary deaths in health care why would you start with 2 practices at the lowest end of the death toll scale? It does seem you have a personal issue with them as you speak to chiropractic and yoga here.
If your intent is to attack medical procedures that lack sufficient (to you)research or studies then man, you have some work to do. It is estimated that less than 15% of medical procedures are backed by double blind studies and less than 1% of medications on the market for what they are prescribed for.
Potential risks if known should be made available to people, yes, hence the informed consent laws being strengthened every year in licensed health care practice but over hyping risk or trying to scare people into not using a procedure under the guise of research issues or saving lives is inappropriate and shows more to one’s personal biases more than anything. The truth is these potential risks do exist and the person your reader should be speaking to about them and listening to for an explanation is your chiropractor and your yoga expert, the ones that actually have some responsibility for what they say and do with this matter.
“why would you start with 2 practices at the lowest end of the death toll scale?”
Because a death is still a tragedy, even if the count is considered trivial by some, and I found the general nature of many of the occurrences to be shocking.
“The truth is these potential risks do exist”
I’m glad that you can admit that.
“If your intent is to attack medical procedures that lack sufficient (to you)research or studies then man, you have some work to do. It is estimated that less than 15% of medical procedures are backed by double blind studies and less than 1% of medications on the market for what they are prescribed for.”
I do not endorse many of the conventional medications and procedures being prescribed by physicians. It would be nice if all of the ones which do not have proven and safe benefits could be restricted.
“the person your reader should be speaking to about them and listening to for an explanation is your chiropractor and your yoga expert, the ones that actually have some responsibility for what they say and do with this matter.”
Hopefully they will all do that now. Not once in my article did I tell people to not do yoga or see a chiropractor, so my blog post might actually spur a reader to have a thoughtful exchange with their yogi or doctor.
I take responsibility for everything I write and say, I am (if you are not aware) a moral human being. I trust that my readers will take what I share and think or act on it critically, if I did not it would be an insult to their intelligence and their capability for critical thinking.
I also try my utmost to provide citations and references for assertions made within my articles. My readers can review the source material at their leisure and come up with whatever conclusions they might arrive at.
I am a chiropractor and utilize it for my income. However, I became a chiropractic believer because it decreased the symptoms of asthma and with the help of my MD over 20 years ago, decreased my meds dramatically. In the last 5 years I’ve also been a student of Paleo and now a percentage of my income comes from educating people about Paleo, as does yours.
In my practice, Chiropractic is utilized as a wellness model and never for pain relief. One has to ask is the risk of pressure on the nerves from subluxation less than or greater than the risk of a possible dissection. I’ve been a chiropractor for 15 years and have yet to meet another chiropractor, physical therapist, osteopath or MD that practices manipulation to the neck (chiropractors adjust, others manipulate) that have caused a dissection. Yet the adverse reactions to drugs and nosocomial infections are I believe a bit higher than 1 in 40,000.
So just looking at this subject from a safety perspective, chiropractic and yoga are pretty darn safe in relation.
As far as effectiveness and necessity of alignment of the spine, especially of the neck and C1 vertebra, this study talks about C1 adjustments only and how it was better than meds for reducing high blood pressure.
http://www.webmd.com/hypertension-high-blood-pressure/news/20070316/chiropractic-cuts-blood-pressure
While I appreciate your scientific mind and your heartfelt desire to make a living by fulfilling a purpose that is so necessary, I don’t think you can speak from a place of authority on Chiropractic…or yoga.
Brad Fackrell´s last [type] ..Here’s to a great 2012
“I don’t think you can speak from a place of authority on Chiropractic… or yoga.”
I don’t think anybody should, arguments from authority are a logical fallacy. Anyway, somebody who is not neck-deep in a particular practice (and doesn’t make money from it) is probably more qualified to analyze data on the topic since they’re less likely to be biased.
I’m keenly aware of my monetary connection with paleo, as you so kindly pointed out, and I make a conscious effort to check any potential bias from creeping into my articles. Regardless though, most would laugh if they found out how little money I actually make off this site. (I wash clothes in my sink to save money on utilities.)
“Yet the adverse reactions to drugs and nosocomial infections are I believe a bit higher than 1 in 40,000.”
Probably true, which is why I don’t recommend people go nuts with pharmaceuticals either.
“this study talks about C1 adjustments only and how it was better than meds for reducing high blood pressure.”
Interesting result, no doubt. I tend to believe the notoriety over blood pressure is somewhat overblown, except perhaps for those with familial hypertension and sensitivity to sodium intake. For everybody else it would probably be more sensible to manage their blood pressure (if even necessary) with diet and lifestyle changes.
Via the World Chiropractic Alliance:
In an attempt to discredit chiropractic and discourage people from seeking care from doctors of chiropractic, some proponents of allopathic medicine continue to disseminate misleading information about a possible link between cervical adjustments and strokes.
It is the position of The World Chiropractic Alliance that such misinformation is a deliberate and unethical scare tactic which does not stand up to critical analysis. Even if we restrict our investigation to cervical adjustments — which have been the focus of many of the media and medical attacks — the only reasonable conclusion which can be drawn is that chiropractic adjustments do not post any significant risk of stroke and are remarkably safe.
A stroke occurs when a blood clot blocks a blood vessel or artery, or when a blood vessel breaks, interrupting blood flow to an area of the brain. The lack of blood causes brain cells to die. There are nearly 750,000 first ever or recurrent strokes each year in the U.S. and more than 150,000 deaths are directly related to strokes.
To link these strokes to chiropractic is absurd, however, since numerous published scientific and medical studies indicate that the incidence of a cerebrovascular accident (CVA) or stroke is estimated at between 1 to 3 incidents per million adjustments.
One study covered a period of 28 years, while another involved reviewing about 110 million chiropractic visits. The results of all these studies show conclusively that the risk of stroke from a chiropractic adjustment is so small as to be statistically insignificant. It has been estimated that it is even less than that of “beauty parlor stroke syndrome” — a rare occurrence triggered when a customer leans her head back on a sink to get her hair washed.
In reality, even the 1-3 incidents per million adjustments figures may be too high, since it is erroneous to equate correlation with cause. That is, if a person suffers a stroke after receiving a chiropractic adjustment, it is not necessarily proof that the adjustment caused the stroke. In an article entitled “Adjustments, Strokes, and Errors in Medicine” (The Chiropractic Journal, July 2000), Christopher Kent, D.C., explained, “The fact that a temporal relationship exists between two events does not mean that one caused the other.”
In addition, medical researchers frequently misunderstand the critical differences between specific chiropractic adjustments and cervical manipulation. Doctors of chiropractic are highly trained in the use of the adjustment, which is the specific application of force to facilitate the body’s correction of nerve interference. Manipulation is the forceful passive movement of a joint beyond its active limit of motion. Since it doesn’t imply the use of precision, specificity or the correction of nerve interference, it is not synonymous with chiropractic adjustment.
Finally, many of the cases cited by medical researchers as being “chiropractic treatments” were actually spinal manipulations rendered by non-chiropractic practitioners. According a research report in the Journal of Manipulative and Physiological Therapeutics, “manipulations” administered by a Kung Fu practitioner, GPs, osteopaths, physiotherapists, a wife, a blind masseur, and an Indian barber had been incorrectly attributed to chiropractors.
The report explained that, “The words chiropractic and chiropractor have been incorrectly used in numerous publications dealing with SMT injury by medical authors, respected medical journals and medical organizations. In many cases, this is not accidental; the authors had access to original reports that identified the practitioner involved as a non-chiropractor. The true incidence of such reporting cannot be determined. Such reporting adversely affects the reader’s opinion of chiropractic and chiropractors.” (Terrett AGJ: Misuse of the literature by medical authors in discussing spinal manipulative therapy injury. JMPT 1995;18:203.)
Despite their apparent desire to malign chiropractic and link adjustments with the risk of stroke, even medical researchers have had to admit that chiropractic care carries far less of a stroke risk than medical treatment. “Indeed, most interventions by allopathic physicians have a higher complication rate than chiropractic interventions,” said Philip Lee, M.D., a co-investigator of a research survey presented at the American Heart Association’s 19th International Joint Conference on Stroke and Cerebral Circulation.
Based on the scientific evidence readily available today, it is clear that chiropractic adjustments pose no significant risk of strokes and are far safer in this regard than most medical treatments. The World Chiropractic Alliance calls upon the medical establishment to provide factual data to the public and restrain from using scare tactics in a blatant attempt to continue its long-standing history of opposition to chiropractic and other disciplines which threaten its monopoly on the health care system.
Case: My brother at 37 years old walked into his MD’s office complaining of facial numbness and dizziness. He stated “I’m concerned I’m having the symptoms associated with a stroke”. Without doing any neuro, tests the doctor diagnosed him with a sinus infection and sent him home with sinus medication (which was contraindicated for those with high blood pressure which my brother had). Long story short he was having a stroke which wasn’t diagnosed until 3 days later by another MD. Did the first MD cause his stroke? No she just mis-diagnosed and mis-treated him. Had he gone to a chiropractor at first and been mis-diagnosed and mis-treated most certainly the chiropractor would have been blamed for causing his stroke.
As per your comment about not accepting articles written in JMPT (an index medicus peer reviewed medical journal) because the articles are primarily written by practioners who manipulate: per that mind set then you should feel the same way regarding The Journal of the Medical Assiciation (JAMA), British Medical Journal (BMJ), Spine, Journal of Bone and Joint Surgery. Don’t those journals have articles primarily written by MD’s and orthopedic surgeons that might be biased. Obviously not, but you can see how having that bias agasnt JMPT is unwarranted. If one is refusing to accept sound medical research then having a reasonable discussion is pointless.
“your comment about not accepting articles written in JMPT”
I did not say I don’t accept it, I said “I am skeptical of it”. It’s poor form to misquote me on my own blog. The distinction is not irrelevant.
The stated purpose of the journal is “dedicated to the advancement of chiropractic health care”. If the only research you are able to present in support of chiropractic procedures is from that journal, then it’s a bit funny to me. I’m allowed to be skeptical, in some academic circles it’s actually considered a useful trait.
“If one is refusing to accept sound medical research then having a reasonable discussion is pointless.”
Soundness and reason are often in the eye of the beholder.
Academic journals are not infallible. See the recent gaffs regarding global warming and vaccinations as examples of this. Seeking evidence with a wider net is typically a good thing.
Either way, I addressed the specific article you posted (Cassidy, et al), you just didn’t agree with my opinion of its conclusions. Coincidentally, I will acknowledge that it was originally published in Spine, and later republished in JMPT.
OK, so you’re just skeptical of JMPT, sorry for the “mis-quote”. I think my point is the same.
I do find it funny however that you’re skeptical of an index medicus peer reviewed journal yet your first two references are traced back to Quackwstch which is an anti-chiropractic website (no bias there!). The founder of Quackwatch, Stephen Barrett, has been sued numerous times for mis-representing the public.
Reference [1] goes to Science-based Medicine, a reputable website with articles written regularly by various medical professionals, with a focus on evidenced-based medical practices. Stephen Barrett is not listed as a contributor to the website.
Reference [2] was the first reference I could find of the death of Laurie Jean Mathiason, whose tragic story can be found at multiple places on the Internet. If the story is also published at Quackwatch it’s largely irrelevant because the information is essentially public record.
The account of the circumstances surrounding her death are pretty well known, especially by chiropractors, since that was effectively what launched the massive investigation of chiropractic in Canada.
So yeah, you’re misrepresenting me again.
I’m closing comments. The adversarial nature of the discussion and the increasingly ad hominem tone of the comments is becoming tedious.