Chiropractic Neck Treatments Increase Risk of Stroke
So what's a tolerable risk?
"It has to be balanced by benefit," says Goldstein. "If there's no benefit, then any risk is not worthwhile. On the other hand, if there is benefit, then we tolerate various levels of risk. Medical therapies are not risk-free. What this does is raise the issue that there is this potential risk, and like anything else we do in medicine, patients need to know about that risk."
Leaders in the chiropractic community take issue with the findings -- and the implications.
"[Rothwell's study] is a deliberate and unethical scare tactic that does not stand up to critical analysis," says Terry A. Rondberg, DC, president of the World Chiropractic Alliance.
"This is pure conjecture," Rondberg tells WebMD. "I see this, frankly, as an attempt to discredit chiropractic and discourage people from seeking the care of doctors of [chiropractic].
"Chiropractors are trained to deliver a chiropractic adjustment," he continues. "Manipulation is not something we do. Manipulation is the forceful passive movement of a joint beyond its active limit of motion. ... It's not synonymous with chiropractic adjustment. And these cases of spinal manipulation are often performed by nonchiropractic practitioners like osteopaths and physiatrists."
As pointed out in Rothwell's study, says Rondberg, the rate of stroke is estimated at 1.3 incidents per one million adjustments given. "Other studies, including one covering a 28-year period reviewing 110 million chiropractic visits, showed conclusively that the risk of stroke from chiropractic adjustments is so small that it's statistically insignificant," he says.
Bottom-line message, says Rothwell: "Any medical procedure has risk associated with it. Consumers should strive to be informed and be aware of risks and benefits and talk to their health practitioners. It's also the duty of chiropractors to inform their patients about the risk."
The findings from her study should compel "the chiropractic community to produce rigorous studies to define the actual benefits of neck manipulation," Rothwell tells WebMD. "There is some research that shows it's beneficial in the short term, but there's not a lot of rigorous research to show benefits."