Chiropractic + Naturopathic Doctor

Death of the Dogma of Critical Injury

By Stephen Silk DC   

Features Research

New research lays ‘The Great Stroke Hoax’ to rest

There are few discussions in chiropractic that invoke more passion – and occasionally fear and panic – than the controversial topic of “Chiropractors Cause Strokes.” While most in the profession obviously recognize, and openly admit, that strokes can occur to anyone at any time, chiropractors should rest assured that the application of a proper chiropractic adjustment to the cervical spine doesn’t increase the likelihood of a stroke happening. In fact, those who actively pursue the science behind this issue will tell you that the supposed “material risk” is baseless. And, recent research can  now confirm it; “The Great Stroke Hoax” is dead. 

As chiropractors, we should not shy away from this issue, cowering from the accusations of those who wish to hold us back. While allegations of the “risk” of chiropractic, with respect to stroke, have been freely made for over 50 years – and have been especially amplified over the past 20 – our detractors have never put up anything more than seemingly “temporally related” anecdotes as their “evidence” to support their position. There has never been anything remotely resembling high quality research to back up their claims. 


Oddly, those making such lurid statements have not been challenged to back them up! Instead, we acquiesced to their condemnations, and began warning our patients – and potential patients – that we might injure or even kill them by adjusting their necks. As a profession, sadly, we acknowledged, accepted and promoted this “risk” without question. Even worse, some within our educational system began to promulgate this fallacy to a whole new generation of chiropractors, creating fear about providing, perhaps, the most essential service we offer. This insidious weakening of spirit may be our ultimate downfall!

The purpose, then, of this article is twofold: to create open dialogue on this topic, and to let you know about two research papers – one published, one about to be published – which when added to previous works, will serve to put the nail in the coffin of the “Stroke Hoax.” 
Adjusting the Upper Cervical Spine
It is my firm belief that if 100 DCs were randomly polled, the vast majority would agree that there is validity in upper cervical care. However, if patients – not to mention practitioners – are frightened of cervical adjustments, then my worst fears may come true: rather than standing up and fighting for what is right, we will wither from within, and slowly fade away. The chiropractic pioneers are rolling in their graves.

Let me be clear at this point: “acting conservatively” is a mainstay in chiropractic, and should continue to be a cornerstone in our patient interactions. Over the years, thorough nerve system analyses, and spinal workups, have led me to find a few “red flags” that required significant technique considerations or, in some cases, medical referral. But almost 20 years of clinical experience allows me to recognize that these “challenging patients” are the minority, and while special care should be afforded them, they should be also be recognized for what they are: rarities.

New Research Supports the Safety of Upper Cervical Adjustments
The first paper, from England, was published in Spine (32(21):2375-2378, October 1, 2007) and its conclusions are thus:
Of the over 50,000 cervical manipulations observed, there were no reports of serious adverse events.  Minor side effects, occurring either immediately after, or within seven days after treatment, were slightly more common. Some of the side effects included:
• fainting, dizziness, light-headedness in, at worst, 16 per 1,000 treatments,
• numbness or tingling in upper limbs in, at worst, 15 per 1,000 treatments,
• headache in, at worst, four per 100 treatments.
This data echoes that of three previous studies –  Spine (1997), 22(4):435-440; JMPT (1997), 20(8):511-515; and JMPT (2004), 27(1): 16-25.  They all point to the fact that the worst possible side effect, after an adjustment, is a little muscle ache, a bit of fatigue and some mild vasodilative responses.  No blown discs, no broken ribs, no strokes. 

The second study, reported at the WFC Conference in Portugal last May and again recently at the Bone & Joint Decade Task force on Neck Pain in Regina, will be published in the upcoming February 2008 edition of Spine. This project, headed by some well-known Canadian researchers, shows that the risk of dissective stroke is no different whether people seek care from a chiropractor or a medical doctor! Since physicians do not routinely adjust necks in their practices, this would strongly suggest that chiropractic neck adjustments have nothing to do with dissective strokes. Add to this the 2002 Symons study in JMPT which showed that to damage a vertebral artery would take 25 times more stretch than was possible with a rotary adjustment, and you can see that the “risk” is an illusion stemming from bad timing rather than a reflection of bad chiropractic. And, of special note, the numbers presented in the study are right around the traditional “one-in-a-million” rarity rates that chiropractors have traditionally advocated. To put that into perspective, consider your risk of death from the following:
• in a car accident  – 13,333 per million,
• from prescription drugs  – 3,200 per million,
• from cigarettes – 1,667 per million, and
• while riding a bike – 12 per million.

As research confines the “risk” of cervical adjustment to minor irritations, at best, while proving that the chances of causing stroke are so remote as to be almost nil, why do some malpractice carriers still insist this critical  – yet scientifically unverifiable – issue be addressed during consultation? It is evident that, based on current data, these overblown and unsubstantiated “known risks” should be withdrawn from currently endorsed “informed consent” (IC) forms immediately.
The time has come to move on
I believe the entire profession owes a debt of gratitude to those toiling in the research community on such mundane, yet vital, issues as this. So to all those involved in these, and similar studies, on behalf of the profession: Thanks!!!

Finally, it is obvious that chiropractic is at a crossroads, a critical mass, a flashpoint, as it were. It is time for each and every one of us to come off the sidelines and get in the game.  It is time, if you truly value the gift you bring to humanity, for all of us to stand up and quit living on our knees before those who would keep us down. It is time to deliver our services to a suffering world with self-respect. Our communities need what we have to offer now, more than ever, since that day in 1895 when D.D. Palmer had his “light-bulb moment.”

Now, more than ever, we need to draw the line so that we can, finally, put this issue to bed and get on with the more important business of getting more people under chiropractic care. The future of our society vitally depends on it.•

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