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

This week, we are in Episode #3 of the 3 part series where we systematically debunk the odd myth that chiropractors cause strokes. I’m almost done with this chiropractors cause strokes myth, y’all. In this final episode of this series, we will discuss risky interventions, papers having to do with the risk, or lack thereof, of chiropractic adjustments to the cervical region specifically, and then a wrap up of the information.

Before we get started with the chiropractors cause strokes myth conclusion, I want to draw your attention to the reviews over at iTunes. If you would be kind enough to leave us a great review we sure would appreciate you! This is a new podcast and we need all the help we can get!

Right now though, it’s time for bumper music!

Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, chiropractic advocacy, and research. Thank you for taking time out of your day I know your time is valuable and I want to fill it with value so here we go.

Let’s begin by thanking those of you that sent even more emails to me after this series kicked off and after the second episode of the stroke series came out last week. It’s good to know you’re listening and finding the value. Again, the best way you can help is to share these three stroke episodes with as many people as you can. We can get this chiropractors cause strokes myth debunked and we can put it to rest right here, right now. But, obviously and once again, I can’t do it myself. I need your help to do it. You have to actively, hit a share button, hit a like button, copy and paste a link into an email, whatever the action may be….you have to actively do it. And I thank you in advance.

I also want to remind you that this is part 3 of a three part series on the chiropractors cause strokes myth. Last week was part 2 where we discussed research papers demonstrating and validating benefits of having cervical manipulation treatments. Or chiropractic adjustments to the neck. We talked about the benefits, according to research, for neck pain as well as for headaches. And we talked a little about where this chiropractors cause strokes myth came from and why it perpetuates to this day.

In part one of this chiropractors cause strokes series, we discussed some risky odds, some case specific discussion, some signs and symptoms of vertebral artery dissection, and some research dealing with common treatments within the medical profession.

Be sure to go back and listen to it if you have not. It’s essential in getting the full picture of the chiropractors cause strokes issue.

Now…off into this episode we go.

I find it interesting and helpful to put ideas into 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?

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.

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   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[10].”
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[1].”
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[2].”
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[3].”
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[4].”
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[5].”
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[6].”
8. Tuchin P, et. al. – “The evidence for causality of vertebral artery dissection from chiropractic is weak[7].”
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[8].”
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[9].”

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 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 chiropractors cause strokes myth, then I will have fulfilled my function.

Key Takeaway:

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.

Next Steps:

SHARE this information and help us get the news out!!

­­­­­­­­Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes.

If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website with more content, products, and chances to learn.

We cannot wait to connect again with you next week. From Creek Stone, my office here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

References

1. Cassidy, e.a., Should we abandon cervical spine manipulation for mechanical neck pain? No. BMJ, 2012.
2. Kosloff T, e.a., Chiropractic care and the risk of vertebrobasilar stroke: results of a case–control study in U.S. commercial and Medicare Advantage populations. Chiropractic & Manual Therapies, 2015. 23(19).
3. Buzzatti L, e.a., Atlanto-axial facet displacement during rotational high-velocity low-amplitude thrust: An in vitro 3D kinematic analysis. Man Ther, 2015. 20(6): p. 783-9.
4. Whedon JM, e.a., Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66 to 99 years. Spine (Phila Pa 1976), 2015. 40(4): p. 264-270.
5. Achalandabaso A, e.a., Tissue damage markers after a spinal manipulation in healthy subjects: a preliminary report of a randomized controlled trial. Dis Markers, 2014.
6. Quesnele JJ, e.a., Changes in vertebral artery blood flow following various head positions and cervical spine manipulation. J Manipulative Physiol Ther, 2014. 37(1): p. 22-31.
7. Tuchin PJ, e.a., Chiropractic and stroke: association or causation? Int J Clin Pract, 2013. 67(9): p. 825-833.
8. Symons BP, Internal forces sustained by the vertebral artery during spinal manipulative therapy. Science Direct, 2002. 25(8): p. 504-510.
9. Church E, e.a., Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus 2016. 8(2): p. e498.
10. Cassidy JD, et. al., “Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-corssover study.” Spin (Phila Pa 1976). 2008 Feb 15;33(4 Suppl):S176-83.

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