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Strokes Due To Chiropractic Manipulation

By June 16, 2008

So is it true that neck manipulations at the chiropractor's office can cause someone to have a stroke? Based on the available evidence it seems extremely likely that they can! This is no joke. There are certain abrupt and not so abrupt movements of the neck which have been associated with strokes caused by vertebral artery dissection, an injury to large arteries that run on each side of the neck, and which bring blood to the posterior parts of the brain. For instance, bending the neck backwards during hair washing at the hair salon, or while painting a ceiling have been associated with a similar injury to the vertebral arteries.

What could cause this to happen? Rapid abrupt movements or manipulations of the neck can stretch the vertebral arteries as they ascend towards the skull, and cause their walls to tear, or rupture. This can either cause a blood clot to form inside the damaged artery, or a significant amount of bleeding to occur. Either of these situations is extremely dangerous as it has the potential to decrease or completely stop blood flow to the most vital parts of the brain. Relatively speaking, this is not such a rare event, estimated to occur as often as 1 in every 20,000 neck manipulations performed by chiropractors.

Some have argued that people who are susceptible to vertebral artery dissection in the first place are the only people who actually become injured by the chiropractic manipulation. This is possible, I suppose, although it is also reasonable to expect that a rapid, and abrupt rotation of a person's neck could accidentally cause even normal arteries to become injured.

What do the studies show? They show a mixture of results. Some for instance have reported that even when controlling for people with neck pain, chiropractic neck manipulation is an independent risk factor for vertebral artery dissection. Others have reported that chiropractic neck manipulation is not a risk factor for stroke at all. Who is right? Your guess is as good as mine. The whole subject seems almost impossible to study, for obvious, (or maybe not so obvious) reasons.

If you are convinced that neck manipulation is the best treatment for your pain, but you suspect that your vertebral arteries might become injured as a result of the abrupt, rapid, rotation of your neck, talk to your doctor about the subject before you start your sessions with the chiropractor.

Recommended reading:
Which Are The Most Deadly Strokes?
Carotid and Vertebral Artery Dissection
What is a Comprehensive Sroke Center?
Injury At The Chiropractor's

Comments
June 19, 2008 at 1:58 pm
(1) Peter says:

Whom ever wrote this has no idea what a chiropractic adjustment entails. Rapid and forceful rotations are not taught in chiropractic school and this article cherry picks from the research to meet a political agenda. Chiropractic is a useful, helpful, scientifically proven healing modality. The M.D.’s have screwed up health care and they don’t like it when people call them out on it. Don’t believe a word of their propaganda.

June 19, 2008 at 4:24 pm
(2) stroke says:

Dear Peter. Thank you for your comment.

I am not aware of the political agenda you are speaking about in your comment. To my knowledge, the studies pertaining to the association between chiropractic neck manipulations and vertebral artery dissection are motivated by an important medical principle: “First do no harm”. By using the scientific method, if an association is made between a given medical intervention and an adverse outcome, intense analysis and debate follows in order to prove or disprove that the benefits of the said intervention outweigh its risks. If the intervention is proven, scientifically, to cause more harm than good, a formal motion is made by pertinent government agencies to stop the intervention from being performed as a standard of practice.

The only agenda enforced by this method is “first do no harm” Another way to think of this is as quality control.

As I mentioned in this blog, similar associations have been made between bending the neck backwards during hair-washing at the hair salon, and vertebral artery dissection. If enough high quality data are produced in the future to prove that the way we get our hair washed at the hair salon today is in fact a public health risk, someone will need to figure out a new way to wash people’s hair at the hair salon without putting people at risk. Perhaps this will be seen by some people as a business opportunity!

I assure you, there is no “political agenda” against chiropractors, hair washing, or hair salons. When something we do regularly has the potential to cause harm, its intense analysis should be celebrated, and supported. In my opinion this is simply the right thing to do.

Once again, thank you for your comment.

June 19, 2008 at 6:40 pm
(3) Peter says:

Doctor,

It seems as though you need to review a few of your own procedures. For example you most likely would tell your patients to take NSAIDS for the same conditions treated by chiropractors. The problem is that NSAIDs KILL 16,500 patients per year in the US alone. NEW ENGLAND JOURNAL OF MEDICINE 1999
340:1888-1899.

NOBODY is killed from an adjustment. Why don’t you accept the fact that Chiropractic is safe and effective for neck and back pain. Those that suffer from VAD strokes are just as likely to have seen a medical doctor or a chiropractor. You know darn well that those people walk into our/ your office with the disection already happening. Many times these VAD cases mimic mechanical neck pain. This makes it difficult or impossible to tease out the VAD cases. You Should be warning people about the dangers of the drugs you perscribe wich are more likely to KILL that any chiropractor.

“We are not dealing, with rationality, science or fact,when it comes to the drug laws. We are dealing with witch hunting, religious fanaticism, vested interests, international conspiracy and 100 Billion dollars in annual illegal profits. I am now of the conclusion that anyone who supports the continuation of the existing drug laws is a traitor to the United States Constitution, an enemy of the American democracy and a supporter of the international drug criminal conspiracy, until proven otherwise. Although they previously might have been able to beg innocence on the basis of ignorance, the information is now so universally available this excuse is no longer viable.”
J.S.Hochman MD
Executive Director
National Foundation for the Treatment of Pain

September 22, 2008 at 1:50 pm
(4) hipAppamPinnow says:

favorited this one, bro

October 12, 2008 at 7:35 pm
(5) Belle Fleur says:

The stats you stated in this article regarding the risk of stroke after neck manipulation are wrong! Get your facts straight before you put something on the Internet. Rather than focusing on the negatives from chiropractic care why don’t you write about the benefits of the profession. Chiropractic does not solely involve cervical spine adjustments. Clearly you know absolutely nothing about the profession. I have an even better idea for you, why don’t you write an article about all the thousands of people medical doctors have killed due to over medicating and surgeries. Focus on your job and leave chiropractors alone. We all have our place in the health system with one common goal, getting patients better.

October 13, 2008 at 9:22 am
(6) Stroke says:

Mr Fleur. Thank you for your comment.

In the medical and scientific world we support our beliefs and associations with hard data published in peer reviewed journals. The association written about in this blog has been made by multiple physicians and has been published in several reputable peer reviewed journals (one of them is cited in the text above).

Though I understand your skepticism about this subject, I think that calling the data which supports this association “wrong” is unfounded. Why are you saying this? Where is the data that proves this association to be incorrect? Please provide a viable argument and we will be glad to recognize it as valid.

And understand that I respect your opinion about the medical and chiropractic professions. But they are not relevant or helpful in resolving this important argument.

February 18, 2009 at 5:51 am
(7) Eric B. Rood says:

Dr. Jose Vega

As a well-educated chiropractic student, I agree that the risk of a vertebral artery dissection, due to manipulation of the cervical spine, is present. However, I feel that current researchers fail to consider many significant variables in their studies, which dramatically alters the accuracy of their results. Some of these variables are as follows:

- Was proper technique used?

In every health care profession, a possibility for human error is always present. Medical doctors have been known to prescribe the wrong medication. Dentists have been known to repair and remove the wrong teeth. Surgeons have been known to amputate the wrong limb.
As you know, proper technique is extremely essential for appropriate treatment. If the health care provider is, in any way, careless with the treatment procedure, unwanted results will most definitely occur. With that said, how many of the vertebral artery dissections said to be caused by cervical manipulation, were actually due to improper technique of those particularly careless chiropractors?

- How many patients, were predisposed to a vertebral artery dissection prior to receiving chiropractic care?

Arteries are typically very strong, and flexible. They withstand the constant bending, stretching and pulling associated with normal everyday movements. If someone has an unknown vascular disorder that causes his or her arteries to present in a weakened state, every normal movement poses the risk of arterial dissection. If a chiropractor manipulates the cervical spine of this type of patient, and a vertebral artery dissection occurs, that manipulation simply initiated what was inevitable. Therefore, it is inaccurate to state that the arterial dissection was caused by the chiropractic adjustment, when in reality it was due to an undiagnosed underlying pathology.

I feel that if the previous information, as well as many other such variables, were considered while researching chiropractic manipulative therapy, the results would show a much lower percentage of injury associated with chiropractic treatment. As a professional, I respect that you have your own opinion of this topic, even if we donít fully agree. Currently, chiropractic research providing accurate information is very minimal, because it typically is presented with a biased opinion. As the profession grows, however, so does the data that supports the techniques that we use. Personally, I am very proud to be a part of the future of chiropractics, and I hope that I have opened your mind a little more to this wonderful, rapidly growing profession.

Sincerely,

Eric B. Rood

March 27, 2009 at 12:29 pm
(8) Vicki L. says:

This does happen and did to one of our recovery room nurses. She saw a chiroprator (one she trusted for 20 years)recently for neck stiffnes and she had a small stroke from a vertebral artery dissection after an adjustment. Luckily she said “call 911 now” because she immediately had facial symptoms. I’m praying for a full recovery for her.

April 5, 2009 at 7:26 am
(9) Seth Gross, DC says:

Dr. Vega,

When considering the concern for stroke following cervical vertebral adjustments, wether true or false, and the obvious concern for the patients safety, would you agree that only a health care professional such as doctors of chiropractic (DC) with their 5000 hrs. of primary care instruction, 500 hrs. in spinal adjusting technique, be the sole deliverer of spinal adjustments, rather than other health care providers (that claim stake to spinal manipulation) ie. MD’s (0 hrs.), osteopaths (0-100 hrs.), or PT’s (0-50 hrs.)?

April 6, 2009 at 6:55 am
(10) Seth Gross, DC says:

Vicky, due to both brevity and description of your alleged experience of an ER nurse experiencing a stroke “immediately” following a cervical spine adjustment, I have doubts to wether this alleged incident occured.
First, more often than not, symptoms of stroke take a little longer than “immediately”. Second, what has “a chiropractor she trusted for twenty years” have to do with it? Twenty years? She must have had a fantastic working relationship with this doctor? Was the DC trying to pull the wool over her eyes?
Just doesn’t add up?

Seth Gross, DC

April 17, 2009 at 11:49 pm
(11) Ned says:

I just started chiropractic treatment and I am still undecided whether or not I should let my chiropractor perform upper cervical manipulation. This is in part due to the numerous articles linking neck adjustment with VAD. However, researching the subject I found that the “methods” under which these studies were performed were (I my opinion) flawed. Some of them (not all) look more like a witch hunt to me. I found this article which mentions a study by Canadian researcher that does not necessarily contradicts most of the older studies but put it in perspective. I would invite you to read it at http://www.highlighthealth.com/health-news/chiropractic-adjustments-and-artery-dissection-is-your-neck-in-safe-hands/. Just to be clear I am not trying to convince anyone either way. I am a sceptic about chiropractics in general. I do not believe that all my aches and pains will be cured by a simple realignment of the spine but I do think there is a benefit when it come to back and neck pain. I would just like to find an “unbiased” article siting recent studies that could help me make a decision.

April 19, 2009 at 9:09 pm
(12) Seth Gross, DC says:

Ned, In my 20 years as a chiropractic doctor seeing 500 pv/week, have never personally experienced nor heard of another practitioner (DC) accused of delivering a cervical spine adjustment that resulted in a stroke. You hit the nail on the head, a witch hunt it is!
Ned, a word about you feeling chiropractic is not being able to address all your aches and pains. First, I commend you along with the other 35,000,000 + Americans recieving chiropractic health care each year.
Doctors of Chiropractic are the most educated (5000+ contact hours vs medicines 4600 hrs.) and fastest growing primary health care provider in the U.S.
Your particular chiropractic doctor may be primarily focused on alleviatig spinal subluxations and/or structural reformation of the primary curves of your spine. This is fine and will hopefully arrest vertebral disc and joint deterioration that often cause nervous system abberations.
However, most chiropractic doctors engage the patient in both structural and lifestyle counseling (think of everything, nutrition and including elimination of prescription drugs). This is the style of health care I provide. It is very safe and almost always leads to resolution of the “crux” of poor or declining health and ushers in wellness care.
Due to your (and just about everyone you know) indoctrinization into the allopathic (medical) paradigm of “health care” or better, “symptom and crisis care”, adaptation or adoption of the holistic health care model is difficult and confusing at first, but eventually leads you to the logical understanding that “this” was the correct path to address your health from the start, before you allowed yourself to slip into dis-ease.
Adopt a chiropractic or holistic lifestyle and you will most definitely reach and maintain your health goals.

July 5, 2009 at 12:43 pm
(13) Don Briggs says:

Dear Doctor, where do I begin? On November 27th 2008 I visited a chiropractor. He did a small adjustment of my lower back which was slightly bothersome to me at the time but very small. This was intended to be a ‘feel good’ exercise and one that many others were doing. He then had me lay on my back with my head in his hands. Then he abruptly and forcefully twisted my head to the left and nothing happened. Then to the right with some popping noise. He then asked me to make a fist with my hand and wiggle my foot. Then he once again quickly twisted my head to the left and i felt and heard violent popping! About 2.5 hrs later I started experiencing vision changes and a generally strange feeling in the afternoon and evening. By the evening I was also dizzy. The next morning in general I felt extremely wierd with dizziness. By the evening I was flat out ill. I am not sure how to explain other than I told some people that I thought I was going to die. By the morning I was overcome with facial numbness and I visited an MD. The MD noticed something regarding my eyelid or eyebrow and ordered an ambulence for transport to the hospital. While a patient there I underwent blood and urine tests, MRI and heart stress tests. The only remarkable thing was ‘ischemic white matter changes of the brain’. Believe it or not, I was relaeased and feeling better. Three days after the intial incident I revisited the same chiropactor. He was aware of my issue and subsequent hospitalization. Nevertheless he performed radical manipulation of my head just as he did the first time. Within 30 mins I was overcome with total facial numbness and also lack of sensation on other parts of my body. I was dizzy, one of my pupils was dialated, complete loss of taste and smell and I exerienced some problems with speech. mostly difficulty being able to verbalize the word that I wanted to say. I visited the MD again and also a neuolagist and also a followup MRI. Noone claimed to know what was wrong with me. About three months later a nuerologist diagnosed me with Vascular dissection from chiropractic manipulation of the cervical spine. he ordered and I completed an MRA but it was unremarkable. The neurologist was not surprised given the amount of time that had passed! Now it is eight months later and I am still trying to recover. I have regained taste and smell. I do not have dizziness any longer but I suffer from neck pain, headaches and straightening of the cervical spine. in short my life has changed dramatically! The more active I am the more I suffer. I still have numbness and I have to check often to make sure I am not drooling. I have one question and one statement. How can I help in my recovery from this manipulation and subsequent stroke? And by all means, please never let anyone manipulate you cervical spine!!! The risks far outweigh the possible rewards. And if you think this does not happen (i knew nothing about this before the events)…think again. Sad to say, it is very real! And similar to some of the postings I have read here, many medical professionals are ignorant to these cervical manipulations and strokes or they are protecting the crazy medical professionals that routinely perform them?!! Please reply and thank you.

August 8, 2009 at 9:45 pm
(14) Lynn says:

I had a stroke b/c of neck manipulation and thankfully my arteries were not cut. But a stroke none the less that caused damage and there was found to be NO MEDICAL REASON but the fact that this chiropractor adjusted my neck and I passed out and woke to vomitting and the room spinning. Neck manipulations should be stopped and I for one am going to everything I can to help it along! Doctors are seeing patients die do to the quackery of the one in my area that is doing the neck manipulations and that was said to me by a doctor that also wants these creeps stopped. They are only out to maximize their wallets!

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