ST. PAUL, MN (American Academy of Neurology) -- Neck and spine adjustments by chiropractors and other practitioners can increase the risk of stroke, according to a study published in the May 13 issue of Neurology, the scientific journal of the American Academy of Neurology.
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May 13, 2003
By Robert H. Shmerling, M.D.
Harvard Medical School
How does this article relate to me?
Here is the central question posed by this article: Can chiropractic manipulation of the neck cause stroke or other serious injury to the blood vessels in the neck? While a definitive answer is not provided, the study described here raises the possibility that spinal adjustment in the neck may be dangerous.
Neck pain is common and the cause is uncertain in most people. Arthritis, muscle spasm or tension and disc disease account for most cases. When the simple measures, such as heat or mild pain relievers (such as acetaminophen or ibuprofen) do not solve the problem, it may seem reasonable to visit a chiropractor ? and thousands of people do so regularly. In addition, many people see chiropractors to prevent problems in the spine and elsewhere, even if they have no pain. Although the benefits of chiropractic manipulation have not been scientifically proven (at least in my opinion), the vast majority of treatments seem safe and without complications.
However, researchers in this article found that people under 60 with stroke or the warning signs of stroke (called transient ischemic attack, or TIA) due to tears in the arteries of their neck had recently had neck manipulation with a chiropractor significantly more often than those who had other types of strokes. This is not quite the same as saying the neck manipulation caused tears in the neck arteries, but the association is difficult to ignore.
What changes do I need to make?
It is difficult to know what to recommend based solely on this report. One approach would be to avoid neck manipulation because it may be associated with tears in the arteries of the neck (a condition called dissection). On the other hand, many people swear by the benefits of spinal adjustments and would not want to give them up for a possible risk that even if present is likely quite small.
In my opinion, a reasonable approach would be to see your primary-care physician about your symptoms of neck pain. After a review of your symptoms and your past medical history, your doctor will perform a thorough examination and may recommend tests to determine the cause of the pain and to rule out serious problems. Try conservative measures (without chiropractic manipulation) such as heat, massage, pain relievers, or muscle relaxants. A physical therapist can help develop a stretching and exercise program for you; a review of your home or workplace may reveal simple measures that reduce your neck pain, such as changing the position of your computer or television. Take breaks from any activity that requires you to keep your head and neck in one position for a prolonged period. If you do decide to pursue chiropractic care for your neck pain, the results of this study and the potential for dissection and stroke should be discussed. If you have neck pain that increases after chiropractic manipulation, see your physician immediately. If there has been recent trauma or surgery in the region of the neck, fever or significant neck arthritis, it is best to avoid neck manipulation altogether.
What can I expect in the future?
I believe that different people will interpret this study in different ways. Some will point out that chiropractic manipulation of the neck is safely performed thousands of times each day and the risk of a tear in a neck artery is probably quite low. In addition, there may be factors about the people who have neck artery dissections (or the chiropractors they saw) that differ from those who experience relief of pain without complications. For example, in cases of dissection, perhaps the manipulation was particularly vigorous or in some other way unusual (and different from the standard, recommended technique); or perhaps the people who suffered dissection had vascular disease or particularly flexible necks. Others will review this article and conclude that neck manipulation by chiropractors is dangerous and worth avoiding.
Look for additional research not only to confirm (or argue against) an association between neck artery dissection and chiropractic manipulation but also to figure out how big the risk is and whether there are other factors that affect that risk.
You can expect the advocates of chiropractic manipulation to enthusiastically challenge the results described here. Only additional research, however, will shed light on the true risks and benefits of chiropractic care for neck pain.
Related Areas:
Stroke
TIA
CAM
