Is chiropractic safe?

This is a question that I am often asked as a chiropractor. The cervical adjustment or neck adjustment as it is commonly know is often the most common aspect of the chiropractic adjustments that is brought in to question. More specifically the cervical adjustment is often accused of causing VBS or stroke. This is a rare cause for stroke, arterial dissection occurs when one of the neck arteries supplying blood to the brain is torn. A stroke can occur when a clot, formed on the torn membrane, is dislodged and subsequently travels to the brain, blocking circulation. There have been many campaigns to scare the public away from chiropractic care based on VBS but this is not a claim founded in scientific research it is mainly biased on the opinion of a small number of health care providers. The association occurs because patients tend to seek care when they’re having neck pain or headaches, often conditions treated by chiropractors. Sometimes they go to a chiropractor, sometimes they go to a physician. But But according to a Canadian study there is no increased likelihood of them having this type of stroke after seeing a chiropractor, according to a story published in the Saturday’s Globe and Mail, Toronto, {Published Saturday, Jan. 19, 2008 12:53AM EST; Last updated Monday, Mar. 30, 2009 2:47PM EDT: http://www.theglobeandmail.com/life/article16388.ece} “The findings, published today in the journal Spine, help shed light on earlier studies that had cast a cloud on the chiropractic profession and suggested that their actions resulted in some patients suffering a stroke after treatment.” This Canadian study concluded ” there is no increased risk related to chiropractic treatment in the heated debate about whether neck adjustments can trigger a rare type of stroke.” The difference in this study was that the researchers checked the prevalence of visits to chiropractors and to medical doctors as it related to VBS. {see the abstract http://journals.lww.com/spinejournal/pages/articleviewer.aspx?year=2008&issue=02151&article=00019&type=abstract}

 This is just one such study and one of the most recent.

This study is important because it refutes the conclusion that chiropractic is the cause for these strokes. But for decades it was assumed although not prove that chiropractic was the cause and there were many studies done on the rate of these incidents. Here are a handful of these studies including those with the highest averaged incidents.

The following information is taken from Vertebrobasilar Stroke, by Allan G.J. Terrett

INCIDENCE OF VBS FOLLOWING SPINAL MANIPULATIVE THERAPY (SMT):

1972 – Maigne suggested: “There is probably less than one death of this nature out of several tens of millions of manipulations.”

1978 – Cyriax stated: “…this risk works out to about one in ten million manipulations, and is no argument against manipulative reduction in suitable cases.”

1981 – Hosek et al suggested: “…we may form a conservative likelihood estimator by looking at the ration of vertebrobasilar injuries to adjustments performed. This ration would be 100 injuries per 100 million adjustments…one in about one million.”

1983 – Gutman concluded: “There are 2-3 serious incidents involving the vertebrobasilar system occurring in 1 million manipulations to the upper cervical spine.”

1993 – Carey found: “In a study of a five year period (1986-1990), using statistics from Provincial Governments of Canada, the Canadian Protective Association, and reported legal/insurance claims, concluded an incidence rate of one in every 3,846,153 neck manipulations. None involved death, one had complete recovery, six had some neurologic deficit, four completely resolved, and two had psychological problems, but no physical deficit. If the Province of Quebec were isolated, with 14 million manipulations performed and only one CVA in a five year period, there would be an incidence of one in 14 million.”

1995 – Dabbs and Lauretti following their research wrote “…in a three year period 1991 to 1993, NCMIC closed a total of 96 claims for cerebrovascular accident. Of this total, 61 were closed with payment and 35 were closed without payment. If one concludes that there was little or no merit to the 35 claims that were closed without payment, this would average 20 cerebrovascular accident claims per year. This figure was recently accepted by a popular consumer magazine as a correction to a previously published article (Corrections. Consumer Reports March 1995, page 132). Because NCMIC insures about one-half of the US chiropractic profession, their members should be similar to the national average…Curtis and Bovee report that rotary adjustments of the cervical spine make up about 30% of the visits made to chiropractors. Therefore, chiropractors insured by NCMIC each performed some 1,800 cervical manipulations in each of the three years reported above. Considering these numbers, we calculate that NCMIC’s 24,000 D.C.’s perform some 43 million cervical manipulations per year. Twenty post SMT strokes indicate a rate of less than one stroke per 2 million cervical manipulations.”

As you can see at the worst rate off incidence is 1 in every one million adjustment and can be as high as 1 in 10,000,000 adjustments or less. In the article Death by Medicine By Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD, {http://www.webdc.com/pdfs/deathbymedicine.pdf} “The most stunning statistic, however, is that the total number of deaths caused by conventional medicine is an astounding 783,936 per year. It is now evident that the American medical system is the leading cause of death and injury in the US. (By contrast, the number of deaths attributable to heart disease in 2001 was 699,697, while the number of deaths attributable to cancer was 553,251.5)”. Compare these number to the 20 stokes a year associated to chiropractors in the NCMIC study and also take in to account the Canadian study that indicates that this is probably due to the patient having the condition before seeing a chiropractor and you can start to form a complete picture of the situation.

Chiropractic is safe! and has been for over 100 years.

It is the misconceptions of a few that leads to the perception that chiropractic is not safe. The VBS are the only death that have ever been attributed to chiropractic care but as demonstrated by the scientific research and literature the mortality rates are extremely low and that is only if chiropractic causes the strokes there are now studies indicating that it is just a coincidence caused by the fact that people seeking care for neck pain or headaches from chiropractors may already have these aneurysms. If you think you need a chiropractor feel safe to contact them. Chiropractic is safe and since many chiropractors screen for vertebral basilar insufficiency one of which is the VBS you might just find the chiropractor saving your life. Chiropractic care is safe.