While manipulation of any kind has the potential to cause injury, stroke caused by neck manipulation is of greatest concern. Risk must always be weighed against benefit when upper neck manipulation is considered. Risk of stroke caused by neck manipulation is statistically low, but the risk is serious enough to outweigh benefit in all but a few rare, carefully selected cases.
When the RAND (Research and Development) organization published its review of the literature on cervical spine manipulation and mobilization in 1996, it concluded that only about 11.1% of reported indications for cervical spine manipulation were appropriate and that stroke and other serious complications occurred about 1.46 times per one million neck manipulations.1 In the same year, after examining 183 cases of vertebrobasilar stroke that occurred from 1934 through 1994 following neck manipulation, the National Chiropractic Mutual Insurance Company (NCMIC) concluded that “It has to be accepted that VBS [vertebrobasilar stroke] following SMT [spinal manipulative therapy] does occur.”2
Some time ago, I learned that a Seattle chiropractor, Johanna Hoeller, had been featured on a local TV newsmagazine show. She was so proud of the segment that she had it posted on her web page for all to see. Unfortunately it is no longer there, so I’ll have to tell you what it showed.
She demonstrated her techniques on-camera. She put one wrist on top of the other, held them about an inch away from the patient’s neck and proceeded to produce a cracking sound in her own wrists without touching the patient in any way. The patient claimed to have felt something and to have experienced relief of pain.
The funniest part was when the news crew showed her their video of her performance and pointed out that she had not touched the patient. She appeared to be surprised and responded, “My whole thing is that I’m touching.”
Hoeller practices a form of chiropractic called NUCCA (National Upper Cervical Chiropractic Association). It’s a variant of the hole-in-one idea first proposed by B.J. Palmer, the son of the inventor of chiropractic, D.D. Palmer. Supposedly if you adjust the top cervical vertebra, that will correct any problems in the entire spinal column. Fix one and you fix them all. There is no credible evidence for any of NUCCA’s claims.
So here’s a woman “pretending” to do something that doesn’t work even if you actually “do” it. A little knowledge of psychology easily explains why she has so many satisfied patients. It’s even easy to understand how her experiences may have genuinely convinced her she is doing something effective. What I have trouble imagining is how she first got the idea to try treating without touching in the first place! (more…)