The ‘Stroke’ Myth… Don’t Believe Those Hype!

(UPDATE – As of Tuesday, July 5 2011, the FTC has taken an interest in investigating the slanderous claims made by the VOCA group, considering their claims are not proven in the literature or supported by any facts… Stay tuned…)

Personally, it bothers me that I’m even dedicating a page on my site to address this topic. However, since the rumors have started and the fear-mongering has drawn the drooling, hand-wringing attention of the media, it’s time to stare down the accusations with facts. There has been a lot of misinformation about chiropractic care and risk of causing strokes being propogated by a few angry advocacy groups here in Connecticut.  They have taken their case to the state in a biased attempt to single out chiropractic care and to force chiropractors to discuss the risk of causing strokes (no matter how infinitesimally small) with patients prior to EACH adjustment given.  While I understand that some individuals these anti-chiropractic advocates know have suffered strokes, when the cases were challenged in court – they failed to conclusively prove negligence on the chiropractors’ part. Conversely, they prove the chiropractor to have been diligent in his/her exam in an attempt to rule out the possibility of such an event!  (If you want to read about what the researchers have said about the wonders and benefits of chiropractic, click here!!)

I’ve attended seminars given by expert witnesses on these case here in Connecticut. Personally, while I also find the research to indicate no causative relationship between neck adjusting and VBA (vertebro-basilar accident), I can explain the confusion. Here’s a paraphrased summary of what I was told by a physician who served as an expert witness on the case here in Connecticut:

The case here in Connecticut involved what’s called a ‘spontaneous vertebral artery dissection’. This was caused by normal neck movement and NOT by any treatment rendered. The neck pain experienced from this will usually bring someone into a chiropractors office, but by that time the damage had already been done by the normal movement.  The mere chances of a case of this type coming into a chiropractic office are 1 in 5.7 million – or as often as seeing 50 DIFFERENT people with neck problems EVERY DAY, 7 days a week for 50 weeks each year for 330 years! At that point, you may hear about ONE of these cases come into a chiropractors office!  Only 12-15% of the population sees a chiropractor at any given time. There’s at best a 1 in 7 chance of the above-mentioned scenario even occurring at a chiropractors office! Conversely, it’s 7 times MORE LIKELY to occur after seeing a medical doctor!  In this case, the patient saw 5 physicians for her neck pain. The second of those five was the chiropractor, and it was 57 days after being treated by the chiropractor (and subsequently 3  other physicians) that the incident occurred.  The patient, of course blamed the chiropractor, even though almost 2 months had passed since! Not only did this case walk into the chiropractors office, it walked into 4 other physician offices! Ironically, you don’t hear the media talking about how this was missed by the medical doctors on the case. Cases like this are then more likely to present in a primary care physicians’ office…and did!  I guess it’s just easy to blame the chiropractor!

Also, consider the media bias you don’t hear in the news about the over 15,000 people EACH YEAR that die from taking NSAIDs, do you? Am I to understand that this is an accepted number of fatalities of all the people who take NSAID’s? I don’t see anyone sitting down and talking with someone for 20 minutes to discuss the side effects of these medications – and there is a KNOWN causality there!…but there ISN’T one with stroke and chiropractic treatment, and there’s research out there proving no causality(see below).

In a research study published in Spine by Cassidy et al, it was also concluded that there is no causal relationship between stroke and chiropractic adjustments. It also states that any observed association between a VBA stroke and chiropractic manipulation (as well as its apparent association with PCP visits) is likely due to patients with an undiagnosed vertebral artery dissection seeking care for neck pain and headache prior to their stroke.

Here is the statement from FVS (Foundation for Vertebral Subluxation) regarding the accusation that chiropractic care somehow is causally related to strokes.  There will be more to follow on this, but if there were a risk posed that was worth posting about or that were statistically significant, I would have no problem discussing it. However since no such relationship occurs, it’s inappropriate for me to do so.

In reality, chiropractors are well-trained in screening patients that may be in the higher risk categories for having a stroke. Should someone even fit that category, the administration of adjustments to the neck are most often tempered. In my office, I see patients who have experienced the symptoms of stroke (like numbness, migranes, etc.), but this does not mean they haven’t suffered from one. This is where the clinical exam and diagnostic interpretation come into play. Add to that the treatment plan and the adjustment itself, and the entire clinical picture becomes clearer for who gets treated, and with which treatment.

In an article published in the Journal of the American Chiropractic Association by Michael T. Haneline, DC, MPH, and Gary Lewkovich, DC, and published in JACA (January/February 2007), and as taught to me at Palmer Chiropractic College, cervical spine adjustments should never be performed with the neck in extension because of the SLIGHT possibility that it MAY cause an increased stress on the vertebral artery. However, most chiropractic techniques do not even implement extension in the adjustment process, so your risk level becomes even that much more unlikely.