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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


"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.

"We are concerned that a statement like this can possibly create a fear in a patient, preventing them from making a choice of treatments that may in fact turn out to be the safest choice of all for their neck pain or headache," he said.

In a statement released Thursday, the American Osteopathic Association had this to say about the new statement: "U.S.-trained osteopathic physicians [DOs] use osteopathic manipulative therapy to diagnose, treat and even prevent illness or injury. DOs are taught to conduct thorough evaluations using standard neurological and orthopedic examinations."

The statement noted that osteopaths should not be grouped with chiropractors and physical therapists, who are not physicians and use different techniques for cervical manipulative therapy.

Biller noted that the association between neck adjustments and stroke is difficult to evaluate. People who already have suffered an artery tear may seek treatment to relieve neck pain, which is a common symptom of cervical artery dissection that can precede a stroke by several days.

Because of this, all medical professionals -- including chiropractors and osteopaths -- should be on the lookout for any stroke risk factors occurring in patients seeking help for neck pain or chronic headache, he said.

Overland agreed, adding that chiropractors should discuss the potential stroke risk of neck manipulation with any patient who has other risk factors for stroke, such as cardiovascular disease, family history of stroke or severe headaches.

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