Chiropractic therapy is a popular way to address back and neck pain, but what do you really know about the safety of chiropractic treatment? Following a number of cases of arterial dissection associated with a trip to the chiropractor, some physicians are warning patients to exercise caution over who they consult about neck pain.
Chiropractors are not medical doctors but do undergo thorough training in anatomy and physiology. This means that a quality chiropractor should be able to spot red flags that necessitate referring a patient for more conventional care. A good chiropractor will also spend a significant amount of time getting to know a patient’s medical history and symptoms prior to making any chiropractic adjustments.
The problem with this, however, is that neck pain can itself be a symptom of arterial dissection – one of many potential concerns around chiropractic therapy. A patient who experiences a stroke after seeing a chiropractor may be assumed to have suffered an arterial dissection due to the treatment when, in fact, the condition may have already been present.
What is arterial dissection?
Arterial dissection is rarely the first thing a physician suspects in a patient with neck pain, but it is the most common early sign of arterial dissection. Arterial dissection is more likely in people with weak arterial walls or clogged arteries.
Applying sudden pressure to the cervical spine could tear or dissect the carotid artery and vertebral arteries. These major blood vessels are packed in tight into the small space of the neck and can be damaged through acute neck trauma.
Arterial bleeds, blood clots, and stroke can all result from arterial dissection and may prove fatal or result in permanent paralysis or impairment. There are a handful of reports in medical literature of people suffering from arterial dissection following chiropractic manipulation in the cervical spine.
In cases where a person sees a chiropractor for back pain or another issue unrelated to neck pain, a stroke shortly after treatment or in the days following is more likely to be attributable to the treatment. It is hard to establish cause and effect after the fact, however. This means that the safety of chiropractic treatment remains rather murky.
What to watch out for
Anyone who develops neurological deficits and/or neck and head pain after chiropractic treatment should seek medical attention. These symptoms may indicate an arterial dissection and potential for a stroke. Similarly, patients with such symptoms should seek medical evaluation prior to undegoing chiropractic treatment.
Patients with a respiratory tract infection, migraine, or Ehlers Danlos Syndrome (EDS) should be especially careful about chiropractic therapy. Such conditions appear to be risk factors for cervical artery dissection, meaning that adding another potential trigger is unwise.
Cervical artery dissection is the most common cause of ischemic stroke in young adults. For patients with EDS, fibromyalgia, myofascial pain syndrome, and other health issues that could cause neck pain, chiropractic care may not be advisable due to a higher risk of permanent disability or even death.
Other concerns about the safety of chiropractic treatment
In addition to arterial dissection, chiropractic therapy has also been linked to myelopathy, vertebral disc extrusion, and epidural haematoma. In one review of 46 studies, adverse events were reported in a staggering 33-60.9% of people undergoing chiropractic therapy. Stroke occurred in 5/100,000 chiropractic manipulations, and there were 2.69 deaths per 10 million manipulations (Gouveia et al., 2009).
In conclusion, anyone with a personal or family history of cervical arterial dissections would be wise to consider the safety of chiropractic treatment. Similarly, such patients should be careful to avoid others potential causes of acute neck injury such as skydiving, bungee jumping, roller coasters, trampolining, and contact sports such as rugby.
Ernst E. (2010). Deaths after chiropractic: a review of published cases. Int J Clin Pract, 1162-1165.
Chen WL, Chern CH, Wu YL, & Lee CH. (2006). Vertebral artery dissection and cerebellar infarction following chiropractic manipulation. Emerg Med J, Jan;23(1):e1.
Micheli S, Paciaroni M, Corea F, et al. (2010). Cervical artery dissection: emerging risk factors. Open Neurol J, Jun 15;4:50-5.
Gouveia LO, Castanho P, Ferreira JJ. (2009). Safety of chiropractic interventions: a systematic review. Spine (Phila Pa 1976), May 15;34(11):E405-13.
Albuquerque FC, Hu YC, Dashti SR, et al. (2011). Craniocervical arterial dissections as sequelae of chiropractic manipulation: patterns of injury and management. J Neurosurg, Dec;115(6):1197-205. Epub 2011 Sep 16.