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Neck Adjustments and Stroke: Cause vs Association

Neck pain and some types of headaches are sometimes treated through neck adjustment. Neck adjustment (also called cervical spine manipulation) works to improve joint mobility in the neck, restoring range of motion, and reducing muscle spasm, which helps relieve pressure and tension. Neck adjustment is a precise procedure that is generally applied by hand to the joints of the neck. Patients typically notice a reduction in pain, soreness, and stiffness, along with an improved ability to move the neck.

Although neck manipulation is a remarkably safe procedure, some reports in the media have associated manipulation of the neck with a rare injury to one of the arteries in the neck, which can lead to a certain kind of stroke.

However, the most recent and comprehensive study, published in the February 2008 edition of Spine, reveals that:

  1. That vertebrobasilar artery (VBA) stroke is a very rare event.
  2. Patients are no more likely to suffer a stroke following a chiropractic neck treatment than they are after visiting their family doctor’s office. 1
An Association, Not a Cause

The study, which analyzed nine years’ worth of data, suggests that any observed association between a vertebrobasilar artery (VBA) stroke and chiropractic manipulation is coincidental and most likely occurs when patients with an undiagnosed vertebral artery dissection (stroke in progress) seek care for neck pain and headache before they have a stroke. In other words, patients with a pre-existing arterial injury are sometimes treated by a doctor of chiropractic for what seems to be a simple case of neck pain. Instead, patients’ discomfort turns out to be a slowly evolving case of a neck artery damage.

This rare arterial damage usually occurs spontaneously or following everyday activities such as turning the head while driving, swimming, or having a shampoo in a hair salon.  Patients with this condition may experience neck pain and headache that lead them to seek professional care (chiropractic or medical), but the care they receive at that time is not the cause of the injury. The best scientific evidence indicates that the incidence of pre-existing artery injuries resulting in stroke is extremely rare—about 1 case in 5.85  million office visits.2

When seeking care for a headache and/or new neck pain, be specific when describing your symptoms. An accurate diagnose then dictates the necessary treatment.

symptoms of stroke

Research Ongoing

We believe that patients have the right to know about the health benefits and risks associated with any type of treatment, including chiropractic. Today, chiropractic researchers are studying the benefits and risks of spinal adjustment in the treatment of neck and back pain through clinical trials and literature reviews. All available evidence demonstrates that chiropractic treatment holds an extremely small risk. Our chiropractic physicians take this issue very seriously and are careful to investigate any risk factors in patients, and we enjoy partnering with patients to deliver treatment in the most effective and responsible manner.

References:
1. Cassidy D, et al. Risk of vertebrobasilar stroke and chiropractic care. Spine 2008;33(4S):S176–S183.

2. Haldeman S, et al. Arterial dissection following cervical manipulation: a chiropractic experience. Can Med Assoc J 2001;165(7):905-06.

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