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Chiropractic Manipulation of Neck: Stroke Risk?

American Heart Association releases statement saying risk may be increased if artery wall is torn

WebMD News from HealthDay

By Dennis Thompson

HealthDay Reporter

THURSDAY, Aug. 7, 2014 (HealthDay News) -- Getting your neck adjusted by a chiropractor or osteopathic doctor may be associated with an increased risk of stroke, according to a scientific statement released Thursday by the American Heart Association.

The energetic thrusts and rotations sometimes used in neck manipulation may cause a small tear in the artery walls in the neck, a condition called cervical artery dissection, the statement noted.

A tear in the artery wall can result in a stroke if a blood clot forms at the site and later breaks free to block a blood vessel in the brain.

Such a tear "occurs with a sudden movement that can hyperextend or rotate the neck, such as one you may see with whiplash or sporting events, or even violent coughing or vomiting," said statement author Dr. Jose Biller, chair of neurology at Loyola University Chicago Stritch School of Medicine. "The techniques for cervical manipulation, even though they vary among health professionals, include a rotation of the neck and sometimes a forceful thrust."

These artery wall injuries are an important cause of stroke in young and middle-aged adults, accounting for 8 percent to 25 percent of stroke cases in patients younger than 45, the authors said in background information.

Four large studies have established an association between neck manipulation and stroke in patients 45 and younger, although the evidence does not prove that the practice can directly cause strokes, the paper stated.

Nonetheless, chiropractors and osteopathic physicians ought to warn patients of this link, the statement added.

"We strongly believe that patients should be informed of this association before undergoing neck manipulation," Biller said.

The statement was published in the Aug. 7 online edition of the journal Stroke.

The chiropractic community is aware of the association between neck manipulation and stroke, which is an issue that has simmered for about five years now, said Keith Overland, immediate past president of the American Chiropractic Association and a doctor of chiropractic in Norwalk, Conn.

But Overland said that the evidence remains mixed and inconclusive.

"Two studies that have come out recently said that there is no evidence that the force or direction utilized in cervical manipulation reaches the threshold of stretching the arteries to the point that they can be damaged," he said, adding that professionals who perform neck adjustments apply force that is "no greater than what people can do in activities of daily life."

Overland added that neck manipulation is associated with many fewer stroke deaths than other common medical treatments for neck pain.

Neck manipulation is associated with about one death per 1 million people due to cervical artery dissection, he said.

By comparison, nonsteroidal anti-inflammatory drugs (NSAIDs) cause 153 stroke deaths per 1 million people, narcotic medications cause 53 stroke deaths per 1 million people, and spinal surgery of the neck causes 500 stroke deaths per 1 million people, Overland said.

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