Is There a Connection Between Chiropractic Care and Increased Risk of Strokes

The reports of having a stroke due to a chiropractic adjustment have been greatly exaggerated.

A while back, there was a segment on Good Morning America about the increased risk of stroke associated with chiropractic care.

It’s funny, but IN THE SAME WEEK I saw Robin Roberts on Good Morning America interviewing – of all people!! – a medical doctor about a study that linked chiropractic adjustments to lower blood pressure (1 adjustment caused lower blood pressure that lasted 8 weeks). Watch the YouTube video here. If your computer will not pull up this link you can find the YouTube clip below.

I tell you this because the perception that many people have of chiropractic care is that it’s going to hurt. “Traditional” adjustments, as I’ve heard many patients call them, scare a number of people who might otherwise give chiropractic care a chance.

Many people will ask their medical doctor whether or not they should seek out chiropractic care. To be told by their medical doctor, who has no training in chiropractic adjusting techniques, that it’s dangerous is at best IRRESPONSIBLE and at worst could be considered MEDICAL MALPRACTICE to be dispensing advice about a branch of healthcare they know ABSOLUTELY NOTHING about!

When chiropractic was first developed in 1895, many of the original adjusting techniques were based on osteopathic manipulation maneuvers. Over the last 109 years, many other chiropractic adjusting techniques have been developed, many of which involve NO TWISTING of the neck at all!! But the fundamental difference between an osteopathic manipulation and a chiropractic adjustment is the specificity involved.

“The FEAR-MONGERING opponents of chiropractic who claim that chiropractic is unsafe is akin to Attila the Hun calling Gandhi a terrorist.”

Doctors of chiropractic are highly trained in the detection and correction of spinal misalignments, called subluxations, and use a corrective procedure called an adjustment to remove these misalignments. An adjustment is the specific application of force to facilitate the body’s correction of spinal misalignments that can cause interference to the proper function of the nervous system.

Manipulation, on the other hand, is the forceful passive movement of a joint beyond its active limit of motion. It does not imply the use of precision, specificity or the correction of nerve interference. Therefore, it should not be considered the same as a chiropractic adjustment.

That’s an important concept because many medical doctors, insurance companies, and researchers still don’t understand or differentiate between “manipulation” and “adjustment.”

But onto the subject at hand…

There are many websites full of people who are apparently either trying to discredit chiropractic or scare the general public into thinking it’s dangerous. Most of these sites, articles and sensationalistic media reports are about neck adjustments (in the various sites you’ll see it termed “cervical manipulation” which, as I’ve just explained, is not the same thing). These various chiropractic-bashing sites claim that there is a severe risk for stroke associated with chiropractic adjustments to the neck.

A stroke occurs when a blood clot blocks a blood vessel or artery, or when a blood vessel breaks, interrupting blood flow to an area of the brain. The lack of blood causes brain cells to die.

When they mention chiropractic adjustments that cause strokes, they are always talking about the vertebral arteries, not the more commonly known carotid arteries. The brain gets its blood supply from two sources, the two carotid arteries in the front of your neck (where you would check your pulse) and the two vertebral arteries. After entering the cranium, the two vertebral arteries join to form the basilar artery, which passes upward along the ventral surface of the brain stem. The carotid and basilar arterial systems come together at the base of the brain to form the circle of Willis. This creates a redundant system that provides a measure of backup protection, should one of the other routes fail.

To get to the brain the vertebral arteries actually travel through tiny little channels in the bones of the neck called foramina on their way up to the brain. These arteries are somewhat susceptible to injury at the top of the neck, where they make a sharp turn right above the first cervical vertebra (the atlas or C1 in the neck) and go up through the hole at the base of the skull called the foramen magnum.

The cause of stroke in these cases is called “dissection” of the arteries. You see, the artery has three layers of muscle. The middle layer can develop a weakness, or a tear, causing it to “peel” and roll up. This could block the artery, or narrow the blood flow through that area of the artery; it could also become a place where clots form that may later break off and embolize in the brain. Dissection of an artery may occur spontaneously, or may be related to injury, such as motor vehicle crashes.

The other thing to keep in mind as well is that there is usually an underlying weakness that helped the tear in the artery to occur. Lifestyle factors such as long-term smoking and high blood pressure weakens artery walls. Long-term steroid use could also be a culprit. Even minor neck injuries sustained in yoga, swimming or extending the neck over the edge of a hairdressser’s wash basinhave led to these types of vertebral artery dissections.

Although strokes due to cervical manipulations are few and far between they are seldom missed. However strokes that happen after car accidents are almost always missed.

Most of these various reports feature individual case studies with medical doctors who make it seem like your odds for having a stroke after a neck adjustment are astronomically high. Nothing could be further from the truth. I have the statistics to back it up.

“…this means that PROPERLY PRESCRIBED MEDICATIONS that led to adverse drug reactions would have been somewhere between the 4th and 6th leading cause of death. Only cancer, heart disease and strokes killed more people that year.”

In 1997, there were approximately 158,000 people in the United States that died from stroke, making it around the third leading cause of death in the United States after heart disease and cancer.

Overall, there are about 750,000 strokes per year in the United States. How many of those 158,000 deaths from stroke were caused by chiropractic care?

Well, let’s see…

The National Chiropractic Mutual Insurance Company (NCMIC), which provides malpractice insurance to over 50 percent of chiropractors in the United States, estimates that its 24,000 insured doctors of chiropractic deliver around 43,000,000 cervical adjustments/manipulations per year.

According to a member of the NCMIC Board of Directors (personal communication with Louis Sportelli, DC, Dec. 21, 1994) in the three years of 1991-92-93, NCMIC closed a total of 96 claims for stroke victims; 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 which were closed without payment, this would represent an average of 20 claims per year for incidences where stroke occurred.

So let’s see, that’s 20 strokes per 43,000,000 adjustments to the neck. Well my math puts that at a rate of less than one stroke per 2 million cervical manipulations. It should also be noted that these strokes in most cases, WERE NOT FATAL, meaning they weren’t counted towards the statistics of death from a stroke.

Furthermore, in 1995 a medical researcher named Terrett published a report in the Journal of Manipulative and Physiological Therapeutics, finding that many of the cases cited by medical researchers as being “chiropractic treatments” that led to instances of stroke were actually spinal manipulations rendered by non-chiropractic practitioners. The article states that some of these “manipulations” were administered by – among others – a Kung Fu practitioner, General Practitioners, osteopaths, physiotherapists, a wife, a blind masseur, and an Indian barber. Worse yet, these instances had been incorrectly attributed to chiropractors.

But even WORSE THAN THAT, the report explained that, “The words chiropractic and chiropractor have been incorrectly used in numerous publications dealing with Spinal Manipulative Therapy injury by medical authors, respected medical journals and medical organizations. In many cases, this is not accidental; the authors had access to original reports that identified the practitioner involved as a non-chiropractor (emphasis added by the author). The true incidence of such reporting cannot be determined. Such reporting adversely affects the reader’s opinion of chiropractic and chiropractors.” (Terrett AGJ: Misuse of the literature by medical authors in discussing spinal manipulative therapy injury. JMPT 1995;18:203.)

“…as much as a 25 times greater risk of dying from an ulcer due to taking a prescription Non-Steroidal Anti-Inflammatory Drug like Motrin.”

To sum it up … 750,000 strokes per year; 43,000,000 cervical adjustments per year by chiropractors (remember this is only about HALF of all the practicing chiropractors in the U.S.; the number of cervical adjustments could be as much as 86,000,000) with only 20 incidences of stroke, almost none of them fatal. You still want to tell me how dangerous these adjustments are?

By contrast, there may be as much as a 25 times greater risk of dying from an ulcer due to taking a prescription Non-Steroidal Anti-Inflammatory Drug like Motrin. The number of injuries from vaccines each year was so great that Congress eventually had to enact a National Vaccine Injury Compensation Fund. Just last year, a record settlement was made in which federal health officials conceded that vaccines played a role in contributing to the symptoms of autism in a 9-year old girl. Yet, state funded schools STILL require our children to be vaccinated before they can begin attending.

In 1998 an extensive study published in the Journal of the American Medical Association (JAMA) showed that during the year 1994, in American hospitals over 2,216,000 patients had serious adverse drug reactions and 106,000 people had fatal adverse drug reactions. For that year, this means that PROPERLY PRESCRIBED MEDICATIONS (the authors excluded errors in drug administration, noncompliance, overdose, and drug abuse) that led to adverse drug reactions would have been somewhere between the fourth and sixth leading cause of death. Only cancer, heart disease and strokes killed more people that year.

Where is the outrage?! Where is the reports on local news channels and on nationally televised programs like Good Morning America?

Look at it a different way: 106,000 deaths a year averages out to nearly 300 deaths per day, every day. Deaths from all major airline crashes in the U.S. average less than 300 annually, but one airplane crash gets more media attention and governmental scrutiny than the 300 medication-related deaths which occurred not only on the same day as the airline crash, but also every day before and after for decades!!

Now ask yourself one more time about the risk of stroke from a chiropractic adjustment! It’s ONE IN TWO MILLION!

The FEAR-MONGERING opponents of chiropractic, MOST of whom are medical doctors, who would claim that chiropractic is unsafe is akin to Attila the Hun calling Gandhi a terrorist.

One might argue that these people were sick before they went in the hospital and therefore more likely to have an adverse drug reaction. You could say the EXACT SAME THING about someone who is predisposed to having vertebral artery weakness going to a chiropractor!!

So why does the media sensationalize it so much? I have no idea other than that these news shows need stories. But a closer look at the numbers reveals the truth. You are about 50,000 times more likely to suffer an adverse reaction from medication than you are from a chiropractic adjustment.

A medical doctor named Phillip Lee, a co-investigator of a research survey presented at the American Heart Association’s 19th International Joint Conference on Stroke and Cerebral Circulation concluded that “Indeed, most interventions by allopathic physicians have a higher complication rate than chiropractic interventions.”

If someone has a predispositioned bias against chiropractic, they’re going to find fault with it no matter what. Most medical doctors I meet are not actually against chiropractic, but are often very confused and slightly afraid of it. Some of them actually embrace it.

The ones that sound off most loudly against the chiropractic profession typically have no research or data that is statistically significant. Most of their “findings” are individual case studies of one person, which would never hold up to critical analysis. Or instead, they are surveys of (mostly) neurologists asking them to “estimate” the number of strokes they’ve seen that were related to chiropractic adjustments. All of the figures and studies I could find concerning stroke following “manipulation” involve estimates, not hard data.

Based on the scientific evidence readily available today, it is clear that chiropractic adjustments pose no significant risk of strokes and are far safer in this regard than most medical treatments. The chiropractic profession has a well established record of safety and efficacy, and chiropractors’ malpractice insurance rates remain among the lowest in the health professions.

The profession is leading the way in research to learn more about complications from treatments, and working to reduce them still further. Despite an occasional sensationalistic report in the media, the facts show that chiropractic treatments rank among the safest and most effective form of health care EVER offered.

Visit Dr. Steve’s website, Integrity Chiropractic to get more information about his clinic in Canton, GA.