DEBUNKED: The Odd Myth That Chiropractors Cause Strokes Revisited

UPDATE: Since ‘Debunked’ was originally posted in 2017, yet another paper has come out further debunking the myth that chiropractors cause strokes.

It is titled “A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review”, is authored by Aleksander Chaibi and Michael Bjorn Russell, and published in the March 2019 edition of the Journal of the Annals of Medicine. It can be accessed at this link: https://www.tandfonline.com/doi/full/10.1080/07853890.2019.1590627?fbclid=IwAR3IYn5P5ppJsYymEpHEQe8AmOhNzH8xOfPJaswqNx3EQND-KiCxaXIK7LQ

Conclusion: “……. the reality is (a) that there is no firm scientific basis for direct causality between cervical SMT and CAD; (b) that the ICA moves freely within the cervical pathway, while 74% of cervical SMTs are conducted in the lower cervical spine where the VA also moves freely; (c) that active daily life consists of multiple cervical movements including rotations that do not trigger CAD, as is true for a range of physical activities; and (d) that a cervical manipulation and/or grade C cervical mobilization goes beyond the physiological limit but remains within the anatomical range, which theoretically means that the artery should not exceed failure strain. These factors underscore the fact that no serious AE was reported in a large prospective national survey conducted in the UK that assessed all AEs in 28,807 chiropractic treatment consultations, which included 50,276 cervical spine manipulations.”

Now……that we are up-to-date as of 3/2019, we continue with the rest of the original blog.

This week, we are tackling a myth that has run rampant for years and I hope to once and for all dispel it. The myth is that Chiropractors Cause Strokes. The information could not be clearer on this and we’re going to show it to you in a way that you can understand and in a way that allows you to show it to others. I’m done with this Chiropractors Cause Strokes myth, folks!

 

Unfortunately, you have often read, watched, or heard me complaining about how our profession has been historically attacked by those organizations in charge of the medical profession. I hope those paying attention understand the fact that this is not just sour grapes.

It is education.

It has been proven in the courts that medical associations and organizations aligned together to force Chiropractic out of business. When we talk about profession validation, the history of our invalidation is incredibly important.

I continually bring these facts up in my articles, videos, and podcast because many of the things we talk about have their roots in our history, in the attacks our profession has sustained, and in the attacks our profession is currently battling.

Listen to our series of podcasts accompanying this blog:

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

CF 014: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 2 of 3)

CF 015: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 3 of 3)

From the start, let me state that research simply does NOT support the “Chiropractors Cause Strokes” myth.

Through the RAND Institute, it is estimated that a serious, adverse reaction (such as stroke as a result to a chiropractic adjustment alone) happens in approximately 1 out of every 1 million treatments. Keep in mind the “1 out of every 1-2 million” number as you read through this article.

Let’s put that finding into perspective by comparing it to some other odds.

• The odds of being struck and killed by lightning is 1 in 174,426 according to the National Safety Council.
• The odds of being told to “Come on down,” on The Price Is Right is 1 in 36!
• The odds of being born with 11 fingers or toes is 1 in 500.
• The odds of dying from a firearms assault is 1 in 113.
• How about this one: the odds of winning an Oscar are 1 in 11,500.

Looks like it’s time to move to LA!

Let’s pack up the truck and move to Beverly!

Rather listen to the Podcast version? Click HERE!

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

The simple message is that there is very little (to zero) risk at all of a chiropractic adjustment being the lone cause of a person having suffered a stroke.

If Doctors of Chiropractic were out in the world causing strokes “all of the time,” it would be apparent, it would be obvious, and our malpractice insurance would reflect the fact that a visit to the chiropractor comes with a considerable amount of risk.

To the contrary, we chiropractors have malpractice insurance that costs chiropractors approximately 1/10^thof what it costs our medical counterparts.

Before we start diving off into the research too deeply, I want to talk about a case that happened within the last couple of years (February 2016) that brought the “Chiropractors Cause Strokes” myth back to the forefront. It had to do with the “Queen of Snapchat,” Katie May.

Katie died of a stroke at the age of 34 and, by many, it was immediately assumed the stroke was a result of her two visits to a chiropractor to treat her recent onset of neck pain.

I actually wrote about this case shortly after it originally happened. Initial reports stated that she had a horrible fall while on the set of a photo shoot, which resulted in her neck pain. Then, for some reason, this fact seemed to disappear from further reports.

In addition, initial reports stated that Katie visited either the ER or a medical professional prior to her visits with a chiropractor. The family later denied this so, admittedly, there is some confusion on the matter. Certainly when you consider the family is now suing the chiropractor.

With this information brought back into the reporting, let’s begin breaking it all down.

Katie posted this message to Twitter: “Pinched a nerve in my neck on a photo shoot and got adjusted this morning. It really hurts! Any home remedy suggestions loves? XOXO.”

Keep that in mind as we run through things that can cause a vertebral artery dissection like Katie May suffered. They are as follows:

• Physical Trauma (direct blow to the neck, traffic collision, etc.)
• Strangulation
• Spontaneous (from underlying connective tissue disorder)

According to a paper by Debette et. al., “Trauma has been reported to have occurred within a month of dissection in 40% with nearly 90% of this time the trauma being minor[1]. “

Vertebral artery dissection (VAD) can be particularly difficult to diagnose without the use of a CT Angiogram. For instance, some common symptoms of VAD are as follows:

• Pain and/or numbness in the same side of the face.
• Head pain/Headache that develops gradually and can be dull or throbbing
• In less than 1/5^thof the cases of VAD, people suffer difficulty speaking or swallowing.
• Possible unsteadiness or lack of coordination
• Visual abnormalities
• Hiccups
• Nausea/Vomiting
• Hearing loss

When one reads this list, it seems easy to diagnose a VAD, right?

The problem lies in the fact that VAD rarely presents with these classic signs. VAD commonly presents as a healthy patient that shows up with a headache or neck pain and sometimes both. In fact, it is estimated that more than 80% of VAD cases present with neck pain and headache alone.

Is a medical professional or chiropractor going to refer every single one of these patients for a CT Angiogram or an MRI?

Not very likely.

It is simply not economically feasible to do so and good luck getting insurance companies to cover the costs on all of those CT Angiograms and MRIs!

If Katie did indeed visit a medical professional after her fall, they missed it. Unfortunately, it seems that the chiropractor missed it as well. That does not, however, mean the two professionals are inept. As the website for emedicine.com states, “The focal signs may not appear until after a latent period lasting as long as three days, however, and delays of weeks and years also have been reported[2].”

A study that we will discuss later shows that people commonly present to a chiropractor or a primary practitioner (medical doctor) already suffering an artery dissection before even walking into their offices but assuming the pain is a result of something innocent and simple.

With that being said, I don’t want to be completely biased here. If a healthy person shows up with a headache and neck pain BUT has a history of recent trauma, more exploration is advised, without question. Knowing this, I can relay countless stories of medical doctors having made bad decisions as well. I have heard countless stories throughout my twenty years of practice. A study that we will discuss later shows that people commonly present to a chiropractor or a primary practitioner (medical doctor) already suffering an artery dissection before even walking into their offices but assuming the pain is a result of something innocent and simple. which is why chiropractors and medical doctors both carry malpractice insurance. But, as I mentioned before, chiropractors’ malpractice is approximately 1/10^th the cost of their medical counterparts because, basically, we chiropractors do not typically cause harms in our patients. Malpractice carriers have done their homework and it is clear that there is little to zero risk in going to a chiroparctor.

As we go through more and more papers, it should be clear that Katie likely suffered the VAD as a result of the fall during the photo shoot and the VAD was missed by the medical professionals (if she did indeed go) and then certainly missed by the chiropractor BUT, the chiropractor almost certainly did not CAUSE the VAD. There’s no way he helped it and could have even potentially exacerbated it, but it is highly doubtful and exceedingly rare, that he could have been the lone CAUSE of it.

Some time later, the Los Angeles coroner reported that the chiropractor was the one responsible for Katie’s death. This finding opened the door wide to all of the chiropractic haters to bash away at the profession. Chiropractrors cause strokes….right?

The LA coroner’s office is an appointed position that, in some states, requires little training, to be quite honest. While I am unaware of this particular coroner’s level of training and expertise, this coroner has been under scrutiny for being understaffed and underfunded to mention just a couple of issues. In addition, I would argue that simply because a man or a woman is a county coroner, does not mean they are above being affected by bias or by their profession’s long-held beliefs and teachings. I would say they most certainly are not above influence and, in my opinion, are actually highly likely to be affected by them.

I would also argue that the coroner likely has little to zero knowledge of the current body of research regarding cervical manipulation and the instance of stroke. How could an educated person aware of the body of literature on the matter make a definitive judgement such as this otherwise?

For years, I have experienced nurses, physician assistants, medical doctors, and others in an online setting claiming that chiropractic adjustments are dangerous and ineffective. They claim that commonly, chiropractors cause strokes. A theme amongst them is, “It happens all of the time.” We see it “all of the time.”

Research proves the notion is a lie.

Or, at minimum, it is ignorance and misunderstanding of their experiences.

To put it in plain and simple terms, these detractors wonder why someone would undergo a treatment that is so dangerous for absolutely no improvement. That is in their understanding and in their opinion of course. Again, this simply shows ignorance in regards to the available research. I would like to be less dramatic or inflammatory in my wording but I don’t know of any other way to describe it.

Let’s assume for a moment that this Chiropractors Cause Strokes myth has its base rooted in some sort of fact. Let us be clear. It does not. But, for argument sake, let us say that it does. At that point, we would need to assess the benefits of chiropractic treatment vs. the risks of chiropractic treatment.

In Southern terms, “Is the squeeze worth the push?”

Is there a return on the investment?

Again, this is purely for argument sake because the “Chiropractors Cause Strokes” myth is not real to start with but playing the devil’s advocate can be of use and is almost always entertaining.

Before we step into deeper waters with the research papers, let us discuss benefits & effectiveness vs. risk for some common treatments for spinal complaints in the medical world. If the discussion is focused on doing away with cervical adjustments, what then would be the alternatives and how effective are they?

Basically, if the medical field is looking into OUR backyard, maybe we should take a peek into theirs as well.

It is only fair.

Keep in mind that all of the research we discuss is cited in the reference section so that those of you that wish can easily review these papers independently on your own.

• The opioid crisis cost the US economy $504 billion dollars in 2015and a total of $221 billion to $431 billion in lost economic output due to there being 33,000 opioid-related deaths in 2015[3].
• There were 63,600 opioid-related deaths in 2016, which was an increase of 21% from the 2015.[4].
• Chou R, et. al. – Although the steroid injections for radiculopathy showed some short-term relief in pain and short-term increase in function, the benefits seen in the patients were only small and short-term only. There was no effect long-term and no affect on whether or not the person had surgery eventually. The evidence in this paper suggested there was no effectiveness at all for the treatment of spinal stenosis[5].
• Epstein N, et. al. – “Although not approved by the Food and Drug Administration (FDA), injections are being performed with an increased frequency (160%), are typically short-acting and ineffectiveover the longer-term, while exposing patients to major risks/complications[6].”
• Peterson CK, et. al. – ““Subacute/chronic patients treated with SMT (spinal manipulative therapy) were significantly more likely to report relevant “improvement” compared with CNRI (CERVICAL NERVE ROOT INJECTION) patients.There was no difference in outcomes when comparing acute patients only[7].”
• Chou R, et. al. – “Epidural corticosteroid injections for radiculopathy were associated with immediate improvements in pain and might be associated with immediate improvements in function, but benefits were small and not sustained, and there was no effect on long-term risk of surgery. Evidence did not suggest that effectiveness varies based on injection technique, corticosteroid, dose, or comparator. Limited evidence suggested that epidural corticosteroid injections are not effective for spinal stenosis or nonradicular back pain and that facet joint corticosteroid injections are not effective for presumed facet joint pain[5].”
• Chou R, et. al – “Surgery for radiculopathy with herniated lumbar disc and symptomatic spinal stenosis is associated with short-term benefits compared to nonsurgical therapy, though benefits diminish with long-term follow-up in some trials. For nonradicular back pain with common degenerative changes, fusion is no more effective than intensive rehabilitation, but associated with small to moderate benefits compared to standard nonsurgical therapy[8].”
• Maghout J, et. al. – “Use of intervertebral fusion devices rose rapidly after their introduction in 1996. This increased use was associated with an increased complication risk without improving disability or reoperation rates[9].”

At this point, it is clear the medical field has its own issues to concentrate on and improve upon when it comes to spinal pain and the treatment of it.

The biggest yoke they try to put on our necks is the Chiropractors Cause Strokes myth and,

considering the research, their concerns should be focused in their own playground.

Let us begin a“Risk vs. Reward” discussion with the BENEFITS of cervical manipulation therapy.

If we talk about danger with an intervention, then we have to talk about the risk vs. reward ratio.

I want to start off with the benefits of cervical manipulation for neck pain specifically.

Each paper mentioned includes a short description of the conclusion for each paper cited. Again, each paper is cited in the reference section so that those of you that wish can easily review these papers independently on your own.

1. Korthalis-de Bos IB, et. al. – “Manual therapy (spinal mobilization) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner[10].”
2. Dewitte V, et. al. – “Based on key features in subjective and clinical examination, patients with mechanical nociceptive pain probably arising from articular structures can be categorized into specific articular dysfunction patterns. Pending on these patterns, specific mobilization and manipulation techniques are warranted. The proposed patterns are illustrated in 3 case studies. This clinical algorithm is the corollary of empirical expertise and is complemented by in-depth discussions and knowledge exchange with international colleagues. Consequently, it is intended that a carefully targeted approach contributes to an increase in specificity and safety in the use of cervical mobilizations and manipulation techniques as valuable adjuncts to other manual therapy modalities[11].”
3. Dunning JR, et. al. – “The combination of upper cervical and upper thoracic HVLA thrust manipulation is appreciably more effective in the short term than nonthrust mobilization in patients with mechanical neck pain[12].”
4. Brontfort G, et. al. – “For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points[13].”
5. Puentedura EJ, et. al. – The objective of the paper was as follows: “Thrust joint manipulation to the cervical spine has been shown to be effective in patients presenting with a primary report of neck pain. It would be useful for clinicians to have a decision-making tool, such as a clinical prediction rule, that could accurately identify which subgroup of patients would respond positively to cervical thrust joint manipulation.” In the results, they showed if 3 or more of the 4 attributes were present,” the probability of experiencing a successful outcome improved from 39% to 90%[14].”
6. Yu H, et. al. – “Chiropractic management of atlantoaxial osteoarthritis yielded favorable outcomes for these 10 patients[15].”
7. Puentedura EJ, et. al. – “Patients with neck pain who met 4 of 6 of the CPR criteria for successful treatment of neck pain with a thoracic spine thrust joint manipulation demonstrated a more favorable response when the thrust joint manipulation was directed to the cervical spine rather than the thoracic spine. Patients receiving cervical thrust joint manipulation also demonstrated fewer transient side-effects[16].”
8. Miller J, et. al. – “Moderate quality evidence supports this treatment combination (cervical manual therapy combined with exercise) for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash[17].”
9. Hurwitz EL, et. al. – “Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain[18].”
10. Muller R, et. al. – “In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit[19].”
11. Zhu L, et. al. – “There was moderate level evidence to support the immediate effectiveness of cervical spine manipulation in treating people with cervical radiculopathy[20]
12. Giles LG, et. al. – “The consistency of the results provides, despite some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication[21].”
13. Bronfort G, et. al. – “Our data synthesis suggests that recommendations can be made with some confidence regarding the use of spinal manipulative therapy and/or mobilization as a viable option for the treatment of both low back pain and neck pain[22].”

There you have a fairly thick list of research papers demonstrating the effectiveness of chiropractic adjustments for uncomplicated neck pain but neck pain is not the only reason to have a chiropractic adjustment delivered to the cervical region. Another very common reason for neck adjustments would be for the treatment of acute and chronic headaches.

Chiropractors see headache patients in their offices daily and research shows us those patients are in the right place for the best, non-pharmacological treatment of the complaint. In fact, I have an episode of this Chiropractic Forward Podcast (https://www.chiropracticforward.com) that dealt with a paper showing the effectiveness of chiropractic for headaches.

It was Episode 006 and is linked below.

Here is a listing of papers demonstrating the benefits of cervical manipulation for headaches. Each paper mentioned includes a short description of the conclusion for each paper cited. Again, each paper is cited in the reference section so that those of you that wish can easily review these papers independently on your own.

1. Malo-Urries M, et. al. – “Upper cervical translatoric spinal mobilization intervention increased upper, and exhibited a tendency to improve general, cervical range of motion and induce immediate headache relief in subjects with cervicogenic headache[23].”
2. Espi-Lopez GV, et. al. – “In short, manual therapy techniques and manipulation applied to the suboccipital region for four weeks or more showed great improvement and in effectiveness for several aspects that measure the quality of life of a patient having suffered from tension type headaches[24].”
3. Dunning J, et. al. – “Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with cervicogenic headache, and the effects were maintained at 3 months[12].”
4. Hurwitz EL, et. al. – “Utilization and expenditures for headache treatment increased from 2000 to 2009 across all provider groups. MD care represented the majority of total allowed charges in this study. MD care and DC care, alone or in combination, were overall the least expensive patterns of headache care. Risk-adjusted charges were significantly less for DC-only care[25].”
5. Bronfort G, et. al. – “SMT appears to have a better effect than massage for cervicogenic headache. It also appears that SMT has an effect comparable to commonly used first-line prophylactic prescription medications for tension-type headache and migraine headache[26].”
6. Bronfort G, et. al. – “Chiropractic is effective in acute, subacute, and chronic low back pain, migraines and headaches originating from the neck, for the treatment of some forms of dizziness, extremity and joint issues, as well as mid back and acute and subacute neck pain[27].
7. Tuchin PJ, et. al. – “The results of this study support previous results showing that some people report significant improvement in migraines after chiropractic spinal manipulative therapy. A high percentage (>80%) of participants reported stress as a major factor for their migraines. It appears probable that chiropractic care has an effect on the physical conditions related to stress and that in these people the effects of the migraine are reduced[28].”
8. McCrory D, et. al. – “Cervical spinal manipulation was associated with improvement in headache outcomes in two trials involving patients with neck pain and/or neck dysfunction and headache. Manipulation appeared to result in immediate improvement in headache severity when used to treat episodes of cervicogenic headache when compared with an attention-placebo control. Furthermore, when compared to soft-tissue therapies (massage), a course of manipulation treatments resulted in sustained improvement in headache frequency and severity[29].”

Many headache patients present to chiropractors after a considerable amount of time spent taking headache and migraine medications. Medications do not come without consequences. Certainly when taken long-term. Not only have these patients spent a considerable amount of time on medication, they often have endured botox injections, steroid injections, and worse before finally going to the chiropractor.

It is a fact that patients should have the GUARANTEE of the best treatment that does the LEAST amount of harm.

In that spirit, and considering that chiropractic is safe, effective, and non-pharmacologic, it makes sense that the medical field should actually PROMOTE Chiropractic as a viable, if not valuable, treatment for headaches and migraines rather than dismiss it as ineffectual and dangerous.

Having demonstrated study upon study validating the effectiveness and benefits of cervical manipulation for neck pain (acute, subacute, and chronic) as well as for headaches (chronic, acute, subacute, tension-type, cervicogenic, and migraines), we can now focus attention on research papers having to do with the risk of stroke instance (lack of risk) as a direct result of cervical chiropractic adjustments.

But first, where would you think the idea of the Chiropractors Cause Strokes myth might come from? I believe there are at least a few root sources.

• You guessed it: our old friend the American Medical Association and their state association underlings. This group deemed it unethical to refer to chiropractors or accept referrals FROM chiropractors. They tried to run us out of business by conducting conferences about chiropractic and generating literature that was anti-chiropractic. They then dispersed the misinformation down through the channels of the state medical associations all the way out to the medical doctors, nurses, and medical field profession out in the field, and then ultimately to their patient bases. The “Chiropractors Cause Strokes” myth was well within their ability to propagate. When your initiative is to rid the Earth of the chiropractic profession, you take advantage of what you can. The Federal Court decision in Wilk vs. AMA shows the AMA did just that.
• The other likely culprit in my estimation would be patients visiting medical professionals after having been to a chiropractor and having suffering a stroke sometime afterward. I did not say chiropractors “causing” strokes. Research shows us that people are going to chiropractors already suffering arterial tears that are sometimes spontaneous in nature and almost impossible to diagnose in an in-office setting. While chiropractors have a high level of education, there are many out there that are simply untrained at catching red flags and making the proper referral. Other times, patients present with very common symptoms and there are no red flags present whatsoever. The chiropractor treats the patient thinking they are going to help improve a neck complaint or a headache while in reality they may be exacerbating a tear. When the patient reaches the medical professional, the link is easy to make for the uninformed: chiropractors causes strokes.
• Ignorance – The simple lack of knowledge regarding the body of evidence and research that is available on the topic perpetuates the myth. It is clear the benefits are present. It is clear the risks are not. End of story. But if one is ignorant of the literature, then Chiropractors Cause Strokes is plausible (if not likely) in their minds.

I find it interesting and helpful to relate ideas in medical terms. Many times, when one is learning about topics they are unfamiliar with, it helps to familiarize the material by relating it in terms they better understand. Have you ever watched a commercial for a new medicine or pill and, at the end of the commercial, the narrator runs through an obstacle course of side effects and possible harms?

If you have seen those commercials, then it’s crystal clear that prescription medication can be scary and risky but what about more benign, over-the-counter medications?

Briefly, let us discuss some of the other treatment risks patients commonly face with traditional medical interventions.

• Data obtained from the U.S. Centers for Disease Control and Prevention show that more than 300 people die annually as a result of acetaminophen poisoning.
• Beginning in 2006, according to the CDC, the number of people who died after accidentally taking too much acetaminophen surpassed the number who died from intentionally overdosing to commit suicide.
• NSAIDS such as Ibuprofen and Acetaminophen cause at least 16,000 deaths per year and send 100,000 people to the ER in the United States every year.

It is clear that there is risk with ANY sort of intervention when it comes to the living, breathing, constantly changing, human body. There is risk when one chooses to cross the street, walk in a rainstorm, or climb a ladder.

Most do not let these minimal risks control their decisions or instill fear into their hearts so that they refuse to take an action.

The majority of the population subconsciously realizes a risk, understands minimal odds, and takes action accordingly.

What follows is a listing of the papers exploring the RISKS of adverse events as a result of cervical manipulation. Each paper mentioned includes a short description of the conclusion for each paper cited. Each of these papers is referenced in the citation section at the end of this article and can be reviewed independently.

1. Cassidy JD, et. al. – Spanning over a nine year time period and 109,020,875 person-years, the researchers included visits to chiropractors AND primary practitioners. There was no statistical difference between the likelihood of vertebral artery dissection after having seen a primary medical doctor vs. after having seen a chiropractor. The only possible conclusions are 1) Chiropractors and medical doctors are causing strokes on rare occasion. 2) Patients are presenting to the offices of chiropractors and medical doctors seeking relief from symptoms of a vertebral arterial dissection already in progress. Obviously the medical professionals are not manipulating the cervical region so option number one makes the least sense. Cassidy’s conclusion was as follows, “This suggests that patients with undiagnosed vertebral artery dissection are seeking clinical care for headache and neck pain before having a VBA stroke.”
2. Cassidy JD, Pronfort G, Hartvigsen J, et. al. – This article appeared in the British Medical Journal in 2012. “The effectiveness of manipulation for neck pain has been examined in several high quality systematic reviews, evidence based clinical guidelines, and health technology assessment reports. When combined with recent randomized trial results, this evidence supports including manipulation as a treatment option for neck pain,…..We say no to abandoning manipulation and yes to more rigorous research on the benefits and harms of this and other common interventions for neck pain[30].”
3. Kosloff TM, et. al. – “We found no significant association between exposure to chiropractic care and the risk of VBA (vertebrobasilar artery system) stroke. We conclude that manipulation is an unlikely cause of VBA stroke. The positive association between PCP visits and VBA stroke is most likely due to patient decisions to seek care for the symptoms (headache and neck pain) of arterial dissection. We further conclude that using chiropractic visits as a measure of exposure to manipulation may result in unreliable estimates of the strength of association with the occurrence of VBA stroke[31].”
4. Buzzatti L, et. al. – “….the displacement induced with the present technique seems not to be able to endanger vital structure on the Spinal Cord and the Vertebral Artery.   This study also adds to a better comprehension of the kinematic of the atlanto-axial segment during the performance of HVLA manipulation[32].”
5. Whedon JM, et. al. – “Among Medicare B beneficiaries aged 66 to 99 years with neck pain, incidence of vertebrobasilar stroke was extremely low.  Small differences in risk between patients who saw a chiropractor and those who saw a primary care physician are probably not clinically significant[33].”
6. Achalandabaso A, et. al. – “Our data show no changes in any of the studied damage markers. Although this study examined the outcomes in an asymptomatic population, lower cervical and thoracic manipulative techniques seem to be safe manual therapies techniques which cause no harm to the health of the subject. These data may be used as evidence of the safe application of spinal manipulation to healthy subjects. Further studies with a large sample size and a patient population are needed to corroborate the innocuous effects of spinal manipulation[34].”
7. Quesnele JJ, et. al. – “There were no significant changes in blood flow or velocity in the vertebral arteries of healthy young male adults after various head positions and cervical spine manipulations[35].”
8. Tuchin P, et. al. – “The evidence for causality of vertebral artery dissection from chiropractic is weak[36].”
9. Symons BP, et. al. – “We conclude that under normal circumstances, a single typical (high-velocity/low-amplitude) SMT thrust is very unlikely to mechanically disrupt the VA[37].”
10. Church EW, et. al. – “Our analysis shows a small association between chiropractic neck manipulation and cervical artery dissection (CAD). This relationship may be explained by the high risk of bias and confounding in the available studies, and in particular by the known association of neck pain with CAD and with chiropractic manipulation. There is no convincing evidence to support a causal link between chiropractic manipulation and CAD. Belief in a causal link may have significant negative consequences such as numerous episodes of litigation[38].”

A methodical, logical, and systematic stroll through the body of literature shows without a doubt there is indeed incredible benefit in the use of cervical manipulative treatments for neck pain and headaches & migraine complaints while there is no more risk of stroke from treating with a chiropractor vs. treating with a medical profession.

I want this article to be the final word on this Chiropractors Cause Strokes myth. I want it to be the “end all, be all” on the topic but I have lived long enough to know better and have experienced twenty years within the chiropractic profession. I know this information will not change the attitudes of many. But, if this article can be a reference point for learning more about the topic and can be a tool for educating others about this myth, then I will have fulfilled my function.

In conclusion, the benefit and effectiveness has been proven, the risks have been disproven, and the “Chiropractors Cause Strokes” myth is ONCE AND FOR ALL officially and completely DEBUNKED.

In conclusion, the benefit and effectiveness has been proven, the risks have been disproven, and the “Chiropractors Cause Strokes” myth is ONCE AND FOR ALL officially and completely DEBUNKED.

If you would like Dr. Jeff Williams to give this presentation at your seminar or event, please send us an email at dr.williams@chiropracticforward.com for booking and availability.

Chiropractors Cause Strokes Myth References

1. Debette S, “Pathophysiology and risk factors of cervical artery dissection: what have we learnt from large hospital-based cohorts?”. .Current Opinion in Neurology, 2014. 27(1): p. 20-8.
2. Lang E. Vertebral Artery Dissection. Emergency Medicine 2017 January 18]; Available from: https://emedicine.medscape.com/article/761451-overview.
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