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Update: Chiropractic Neck Manipulation and Stroke

Can neck manipulation cause strokes? Most MDs and many chiropractors agree that it can, but some chiropractors disagree. The subject has been covered on SBM before: here, here, here, here, here, here, here, here, and here. We keep returning to the subject not because it is a common problem (it isn’t), but because it is such a devastating one, and because the general public is still not aware of the risk.

A 2012 study published in the International Journal Of Clinical PracticeAssessing the risk of stroke from neck manipulation: a systematic review” concluded:

Conclusive evidence is lacking for a strong association between neck manipulation and stroke, but is also absent for no association.

Despite the uncertainty, they thought the association was strong enough to recommend informed consent be obtained and patients be warned that neck manipulation “may” increase the risk of a rare type of stroke.

A new study in the same journal, “Chiropractic and Stroke: Association or Causation?” applies Hill’s criteria of causation to the evidence and concludes that causality has not been determined. The author is Peter Tuchin, a senior lecturer in chiropractic at Macquarie University in Australia, and a known apologist for chiropractic. I agree with him that the existing evidence is inadequate to conclusively determine causality, but I think it supports a high probability of causality, and the alternate explanations he offers to exonerate chiropractors are questionable. And other factors should be considered, like the many “smoking gun” cases and whether there is any conclusive evidence of benefit to set against the possibility of risk. (more…)

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Adverse Effects of Chiropractic

There is a very good chance that you will feel worse after seeing a chiropractor.

According to a new systematic review, serious complications of spinal manipulation are rare, but 33-60% of patients experience milder short-term adverse effects such as increased pain, radiation of pain, headaches, vertigo and even loss of consciousness. The study, published in the journal Spine, involved searching PubMed and the Cochrane Library for the years 1966 to 2007. They identified additional studies by hand searching. They looked for all articles that reported adverse effects associated with chiropractic irrespective of type of design. They omitted any reports where patients had underlying diseases (osteogenesis imperfecta, expansive vertebral hemangioma, osteoporotic fracture, etc.) that predisposed them to complications with manipulation.

They found 46 pertinent studies:

  • One randomized controlled trial
  •  Two case-control studies
  •  Six prospective studies
  •  Twelve surveys
  •  Three retrospective studies
  •  115 case reports

They recognized that “the heterogeneity of the study designs did not allow conducting a formal meta-analysis.” But they did the best they could to make sense out of what they found. (more…)

Posted in: Chiropractic

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