In the media, as of lately, there has been intense examination of this question as it relates to manipulation of the neck. Much of this information has been taken from an article by
Dr David Phillips. Maybe this will shed some light on the subject and dispel any concerns that you may have caught wind of.
Everything in life that you do has to be assessed as to its risks vs. its rewards. Getting into your car and driving to the store has its risks, but it sure beats carrying groceries in the rain. That’s the reward…convenience. Sure, some neck treatments are safer, but they dont help much either. The reward of getting one’s neck manipulated (or adjusted, as we chiropractors call it) is that you derive the benefit from the procedure to offset the risks. Cervical adjustments are fast, effective, and mainly painless. Acute neck pain, chronic neck pain, whiplash, headaches, equilibrium disorders, arm pain and numbness and many other conditions all respond well to this type of treatment.
Can neck manipulation harm people? Yes, of course it can. Anything that can do good can also do harm. One of the side effects now being scrutinized in the media is the possibility of suffering a stroke after having your neck manipulated. Chiropractors, however, are not the only ones who perform neck manipulations. Lots of other professions do it too: physiotherapists, physiatrists, medical doctors, osteopaths, some massage therapists, and others. Is it safe? In the right hands it is probably the safest medical procedure involving the neck. What is safer? Certainly not drugs, absolutely not surgery, not traction, not short wave, not passive exercise, not any of the common therapies that can effectively be applied to the neck.
There are numerous other scientifically valid connections between people’s necks and suffering a stroke. Such everyday activities as backing up your car, having your hair washed at a hairdress/barber shop, painting a ceiling, sneezing, thrill rides at the fair, wallpapering, yoga, dental work, many sports activites, and the list goes on. These have all been recorded as causes of strokes. Whenever your turn your head to an extreme, you theoretically stretch blood vessels within your cervical spine. Potentially, this momentary stretch can block or tear blood vessels or dislodge a clot. We know that these occurrences are exceedingly rare, but they do happen. In the same manner, complications following neck manipulations are exceedingly rare. It is quite possible that unfair correlations happen, or coincidence, when a patient presents in the chiropractor’s office for a headache; common symptom associated with a pending stroke. Most chiropractors see many patients for headache pains on a daily basis because chiropractic is extremely effective for managing headaches. So the problematic scenario happens when the chiropractor assesses the patient with the headache, and adjusts the patient. Later that evening, the patient is admitted into the ER after having a stroke. The patient could have chosen to stay at home and rest to rid the headache, or could have visited their MD. There choice was to visit their chiropractor because chiropractic adjustments have been effective in the past. The stroke was inevitable. It would have happened regardless of where or how this patient chose to handle their headache symptoms. Unfortunately, for the chiropractor, the stroke will likely be attributed to the adjustment.
So why are chiropractors being singled out? I’m sure there are many reasons for this unfair spotlight. Partly because we do more neck adjustments than anyone else, partly because we have always been the whipping boy of medicine. Partly because the media loves to sensationalize. In addition we have attained great strides in acceptance over the past few years, mainly for lower back pain, and because there is a good deal of interprofessional jealousy over our domain and success of spinal care.
As mentioned above, the all too familiar scenario is that when a person enters the hospital with a stroke and mentions having seen a chiropractor recently, the attending medical personnel attributes the blame to the adjustment. In many cases the time lapse between the chiropractic visit and the stroke symptoms can be an unreasonable period of time, days, or weeks. The patient is not assessed for having been to a hairdresser, or an air show, or asked if they have painted a ceiling, or backed up their car recently. This accusation is grossly unfair and even blatantly dishonest. In 1992, an Australian researcher compiled a list of 430 cases of what he called “cerebrovascular catrastrophies” the majority of which he blamed on chiropractors. It turned out that he played fast and loose with his definition of the word “catastrophe” and that only 50 cases could be fairly attributed to chiropractic. The rest were manipulations by some of the other professions listed above using techniques he called “chiropractic”. Considering that our profession is over 107 years old, 50 cases by any standard is remarkable. To put that number into perspective, the American Medical Association recently stated that the leading cause of death in the US is from drugs, and the third leading cause is from mistakes in the hospitals.
So how often does harm result from an adjustment of the cervical spine? Recent studies have placed the risk ratio to anywhere between 1 in 1.3 million to 1 in 6 million. Again, this is exceedingly low for an effective medical procedure. A revealing glimpse of the size of the problem can be seen by asking the firms that supply us with malpractice insurance. An Australian researcher and professor, Allan Terret examined data from one of our largest insurers, NCMIC. This company covers 24,000 chiropractors for malpractice. Terret found 1 case in 2 million. This means that for ever 25 chiropractors, who practice full time for 40 years, may see 1 case of stroke in his/her practice lifetime. In other words, the vast majority of us chiropractors practicing every day will never see any serious side effects from the neck treatments he/she delivers and we won’t know any other chiropractor who will.
