Article repositions DCs with respect to cervical manipulation and stroke
By Maria DiDanieli
– Well known chiropractor and researcher Dr. Don Murphy has recently published
a paper titled Current understanding of
the relationship between cervical manipulation and stroke: what does it mean
for the chiropractic profession?
was accepted for publication on August 3, and appears in the journal
Chiropractic and Osteopathy, 2010, 18:
reviews the evolution of studies, to date, that have attempted to show
causation between cervical manipulative therapy (CMT) and vertebral artery dissection and stroke
(VADS). From these studies, the paper concludes
that “…based on the best current evidence, it appears that there is no strong
foundation for a causal relationship between CMT and VADS”.
author goes on to say that a more probable reason that the two seem to be
associated is that patients in whom a VADS has already been initiated will go
see a chiropractor, or other manual therapist, due to the headache and neck pain that are
common symptoms of the dissection. The
incident will take its course, resulting in a stroke, independent of whether a
manipulation is performed or not.
author then goes on to point out that there has been a shift, for
chiropractors, from attempting to screen for patients who might be susceptible
to VADS following CMT to enhancing their differential diagnosis with respect to
VADS. He then outlines a natural history and profile for VADS and makes recommendations
for when a DC might want to monitor the patient, and/or refer out for medical
concludes with a discussion regarding how the profession of chiropractic –
which has found itself linked to the VADS conversation – could adopt a public
health leadership position and choose to become educators on the subject, given
the knowledge that the profession has amassed and the lack of information
widely available on this particular stroke disorder. Chiropractors can become involved in
providing valuable and necessary information regarding signs and symptoms of
VADS, in order to educate patients and the public at large.