ICA review of scientific studies highlights chiropractic safety
By Canadian Chiropractor staffFeatures Leadership Profession
August 14, 2014 – The International Chiropractors Association (ICA) has undertaken a review of the scientific and clinical literature addressing issues of the safety and effectiveness of chiropractic adjustive procedures, highlighting the unique safety record enjoyed by the profession.
This is especially significant in light of frequents news stories, often
from less than credible sources, that seek to link chiropractic
procedures with some incidence of stroke, a statement from the ICA said.
researchers frequently misunderstand the critical differences between
specific chiropractic adjustments and cervical manipulation,” said ICA
president Dr. Michael S. McLean.
“Doctors of chiropractic are
highly trained in the use of the adjustment, which is the specific and
scientific application of directional force to facilitate the reduction
of nerve interference. Manipulation is the forceful passive movement of a
joint beyond its active limit of motion. Since manipulation doesn't
imply the use of precision, specificity or the correction of nerve
interference, it is not synonymous with chiropractic adjustment.”
is in this context that the ICA offers the following examples of
compelling, credible research resources on the chiropractic safety
· A literature review published in the September 2013
issue of the International Journal of Clinical Practice and online at
www.medscape.com by P. Tuchin examined 18 studies discussing what the
researchers termed spinal manipulative therapy (SMT) and stroke to
determine if SMT was a causative or associative factor. There have
frequently been undocumented rumors of stroke following SMT. Reports not
based upon any statistical evidence vary from one case in every 400,000
to one in 5.6 million. The prejudicial tendencies by some in the
medical community toward chiropractic have created controversial,
unjustified views of chiropractic SMT having a higher risk of stroke
than other types of SMT.
This literature review attempted to cut
through the unfounded sensationalism and, “…assess any misconceptions
or distortion of the results of studies on chiropractic and stroke.”
This review noted that sixty per cent of strokes occur due to an
abnormal amount of lipids (cholesterol and/or fat) in the blood.
Smoking, hypertension, obesity, cardiovascular disease, types 1 and 2
diabetes, atrial fibrillation, migraines, heavy drinking, infections,
contraceptives, sleep apnea, illicit drug use and other factors also put
a person at higher risk for stroke. Chiropractic adjustments or SMTs
are not listed in the scientific literature as a major factor in stroke.
The researcher Tuchin explained, “The evidence for causality of
vertebral artery dissection from chiropractic is weak.”
The Canadian Medical Association Journal (2001) reviewed the malpractice
data from the Canadian Chiropractic Protective Association (CCPA)
between 1988 and 1997 on stroke claims following chiropractic treatment.
Results showed that 134 million adjustments were performed and only 23
cases involved stroke. “This most recent study establishes such an
extremely low degree of risk that patients can feel confident about the
safety of neck manipulations performed by chiropractors,” according to
Paul Carey, DC, lead author of the study and president of the CCPA.
(Canadian Medical Association Journal, 2001, 165(7) 905-8.)
A study published in the Journal of the Canadian Chiropractic
Association found 13 documented cerebrovascular accidents occurring in
chiropractic patients over a five-year period with some 50 million
cervical adjustments performed. The author concluded that a reasonable
estimate of risk was low at only one per three million neck adjustments.
A review of more than half a million treatments over a nine-year period
at the Canadian Memorial Chiropractic College outpatient clinic found
no incidents of strokes. (Vertebral Artery Syndrome published in the
book Upper Cervical Syndrome: chiropractic diagnosis and treatment).
Not a single case of vertebral artery stroke was found during a study
that involved approximately five million cervical manipulations from
1965 to 1980 at the National College of Chiropractic Clinic in Chicago.
understands the emotion, the complexity and the confusion that
surrounds these issues at times but believes that the research and
actuarial record on this matter demonstrate the exemplary safety record
of the chiropractic profession, and, that chiropractic adjustments
administered by licensed doctors of chiropractic pose no demonstrable,
significant risk of stroke,” the ICA said.
The association urged
all health-care professionals to make consumer and patient safety a
paramount concern. When the level of risk is quantifiable and
significant, providers have a responsibility to offer that data to
patients and potential patients, it said.
“What constitutes a
significant level of risk is open to a diverse range of opinions and
interpretations; however, to pinpoint risk requires that exact data on
causality needs to be present. That causality factor is simply not
present and even the coincidental occurrence of injury from upper
cervical procedures applied by chiropractors is exceptionally rare,
perhaps no more than one per three million neck adjustments.”
strongly supports full-spine care, including upper cervical procedures
as clinically indicated. ICA has come to this position on the basis of
an extensive review of both the clinical research record, the outcomes
and safety data over the past several decades and the teaching
experience offered at chiropractic colleges and in the post-graduate
process through ICA’s Council on Upper Cervical Care.
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