CF 244: Recognizing Cervical Artery Dissection Today we’re going to talk about Recognizing Cervical Artery Dissection But first, here’s that sweet sweet bumper music
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
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You have found yourself smack dab in the middle of Episode #244 Now if you missed last week’s episode , we talked about Chiropractic Adjustments To Avoid Other Procedures & we talked about Male Vets With Chronic Pain. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
Well, I just turned the big 50 people. It hurt a little. I’m not going to lie. I’ve always been one to really value and enjoy being young. I didn’t just go through it without appreciating my abilities and what I could do and accomplish. I loved being an athlete and running and all of that good stuff. They say it’s just a number but that number is engrained in my joints and I feel it. Part of it is a weight thing.
Being 6’ 4” and 275 or so isn’t great for joints of the body so I’m on it. We’ll get that down. I’m determined. So, 50 is blah for me but it’s over and it’s onward ho. I have too many irons in the file to be worrying about birthdays and all of that stuff.
Business is pretty solid for back-to-school. It’s pretty steady. Which is surprising. I’m changing up some marketing in the near future and will share some of my experience on that. I’m a little nervous to dive more into marketing because if I’m honest, I’m at capacity as it is. I saw 27 new patients last week. Just me. We had a total of about 180 visits and that’s just about as much as I can do. But with the type of marketing, we’re going to be trying, we’ll be more likely to only get the patients in here that we want to work with that are already fully committed and motivated. We shall see. But for now, let’s get on with the research. We have some fun ones this week.
Before I do that though, I have to tell you, that Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.
This first and only one this week is getting some attention due to a recent artery dissection suffered by a woman in Georgia. Unfortunate for sure. I don’t know the particulars so we won’t go into that specifically but, when things like this happen, we start seeing more and more about the chiropractors cause stroke thing. Typically, this isn’t true and there is a lot of research backing that up. I want to cover an article today that just came out called, “How to Recognize A Cervical Artery Dissection’ by James Demetrious, DC, DABCO (DABCO 2022) and published in PostGrad DC on July 18, 2022. Kaplowy!
Since this is an article, we’ll dispense with the traditional format and hit the high notes. The arrticle highlights an excellent paper that came out not long ago that we covered here on the podcast. It’s by Chaibi et al (Chaibi A 2018) and was in the Annals of Medicine in 2019. In their paper, they cited high-quality research that affirms
- Manual therapy doesn’t no result in an increased risk of CAD
- There is no strong evidence that manual therapy provokes CAD.
Chaibi and Russell cite high-quality research to support these conclusions:
- The rarity of CAD also makes the provision of epidemiological evidence challenging.
- However, several extensive cohort studies and meta-analyses have found no excess risk of CAD resulting in secondary ischaemic stroke for chiropractic SMT compared to primary care. [2, 3, 4]
- Similarly, retrospective cohort studies have reported no association with traumatic injury to the head or neck after SMT for neuromusculoskeletal pain.
- Studies have disproven any misconception about whether SMT strains exceed failure strains.
- No changes in blood flow or velocity in the VA of healthy young male adults were found in various head positions and during a cervical SMT.
- Thus, these studies support the evidence of spontaneous causality or minimally suggest very low risk for serious AEs following SMT.
For my office, I try my best to minimize the risk to as close to zero as possible. If there is a young person in the office with unilateral neck pain for no reason, especially combined with a severe headache, they’re getting the inquisition, folks. I’m a research nerd and through my years of doing this podcast, I have compiled 19 questions that I feel can give us the best possible screen for CAD. Feel free to use them for yourself. They are as follows:
- Is there any difference in upper arm strength from side to side?
- Is there pain or numbness in one side of the face?
- Can the patient raise both eyebrows equally?
- Is there any difference in the size of the pupils?
- Does the patient have an even smile?
- Is the tongue straight when you have the patient stick it out?
- Do they have a mostly even grip bilaterally?
- Can they perform a resisted shoulder shrug evenly bilaterally?
- Do you have a head pain or headache that developed suddenly and can be sharp or throbbing?
- Do you have a headache that is worse when laying down?
- Do you have difficulty speaking or swallowing?
- Do you have any visual abnormalities?
- Do you have unsteadiness or lack of coordination beyond what you consider normal?
- Are you having any recent onset hiccups?
- Are you having any hearing loss or pulsing tinnitus?
- Are you having any nausea or vomiting?
- Signs of nystagmus?
- Any other neurological symptoms?
- Do they have any light-headedness or fainting, disorientation, unexplained anxiety, disturbances in the ears, tremors, or sweating?
Now, if after all of those questions, you have accurately documented this complaint and should have a good direction forward. Most of the time, after the screen, I’m comfortable moving on. I’ve done my due diligence. However, I’m sure I’ve lost some patients over the years because if some of these are answered yes with no clear explanation for them, they’re getting an MR-A or a CT-A or I’m not working on them. Plain and simple. I tell them my first job is to do no harm. My second job is to make them better. Most appreciate it and are happy to do the imaging.
So, there you go. If you’d like more information on why chiropractors are almost never solely responsible for CAD, I put together a very comprehensive and, I think, entertaining rundown of the information and I did it in various forms so that you could get the info however you like. I put it in a blog on my website at chiropracticforward.com. The blog is called Debunked; The Odd Myth That Chiropractors Cause Strokes. The link can be found in the show notes right here at this point in the episode. https://www.chiropracticforward.com/blog-post/debunked-the-odd-myth-that-chiropractors-cause-strokes-revisited/
I also have it in video form on YouTube with the same title And just to be sure you could get the information in your preferred format, I made podcast episodes covering the same information in depth. The episodes of this podcast are Episodes 13, 14, and 15
I invite you to dive in a bit so you can be on top of it all.
Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. Store Remember the evidence-informed brochures and posters at chiropracticforward.com.
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!
Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!
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Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
- Chaibi A, R. M. (2018). “A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: A comprehensive review.” Annals of Medicine.
- DABCO, J. D. D. (2022). “How to Recognize a Cervical Artery Dissection?” PostGradDC.