A hidden cause of stroke?
Every day of placement brings with it something new to look up and learn about. I already wrote about all the respiratory knowledge that I’ve gained while being on placement in an acute centre but something else that I’ve been learning more about is that some of the patients we see for swallowing issues caused by stroke had their strokes in a setting I never would have expected: their chiropractor’s office.
What might be going on? It’s been suggested that either underlying, pre-existing conditions can be exacerbated to the point where a stroke occurs because of neck manipulations, or that stretching of the main vertebral arteries that run up the side of the neck can cause disintegration/damage, resulting in blockages to blood flow to the brain.(1)
Whether or not the types of neck manipulations done by chiropractors can cause stroke is a highly contentious issue. On one hand, some research exists to suggest that spinal manipulation therapy is unlikely to mechanically disrupt the vertebral arteries (2) and that a stroke caused as a result of manipulation is a very rare event. On the other hand, there have been neurologists advocating for a ban on neck manipulations. In 2002, 62 Canadian neurologists, in association with the Canadian Stroke Consortium issued a warning to the public, saying “the neurological damage that can result subsequent to upper neck manipulation can be debilitating and fatal” (3) and especially warn against these kinds of manipulations being done on children.
The statement went on to point out that there may not even really be any benefit to getting neck manipulations done, and that there is little scientific evidence to support this practise, especially in the face of the risks. They also call for a closer examination of the vertebral arteries during autopsy, to get a “a better estimate of the true incidence of stroke and death secondary to cervical manipulation.”
The warnings made by neurologists may be in the best interest of public education, but chiropractors argue that the incidence of stroke from their practises is being over-represented. In an article by the World Chiropractic Alliance, reference is made to several (uncited) studies that “show conclusively that the risk of stroke from a chiropractic adjustment is so small as to be statistically insignificant.” (4)
As with many issues, more research is needed from both sides. More proof of medical and physiological benefit that can result from neck manipulations needs to be provided by proponents of these types of practises. On the flip side, more concrete evidence of the links between stroke and chiropractic practises is needed as well.
What do you think? Do you visit a chiropractor? Do you feel the benefits outweigh the risks when it comes to neck adjustments? Leave a comment below!