Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Saturday, May 21, 2005

Neck Manipulation and Strokes: References

Nervous chiro customers....
Yes, even cartoonists are aware of the dangers of neck manipulation:

References: Neck Manipulation and Strokes

Chiropractic's Dirty Secret: Neck Manipulation and Strokes

Spinal manipulation: Its safety is uncertain
"One gets the impression that the risks of spinal manipulation are being played down, particularly by chiropractors. Perhaps the best indication that this is true are estimates of incidence rates based on assumptions, which are unproven at best and unrealistic at worse. One such assumption, for instance, is that 10% of actual complications will be reported. Our recent survey, however, demonstrated an under-reporting rate of 100%. This extreme level of underreporting obviously renders estimates nonsensical." -- Dr. Edzard Ernst, British professor of complementary medicine

Neck manipulation may cause strokes

Spin Doctors I: The Interactive Investigation

Spin Doctors II: Manipulating Children

Manipulation of the cervical spine: risks and benefits
“The literature does not demonstrate that the benefits of MCS outweigh the risks.”

The graphs are interesting, especially Figure 2, where the type of practitioner was adjusted according to the findings by Terrett. PTs were involved in less than 2% of all cases, with no deaths caused by PTs. DCs were involved in a little more than 60% of all cases, including 32 deaths.

Before adjusting the numbers according to the findings by Terrett, it looked like DCs were involved in more cases than was actually the case. The revised figures made DCs look a very little bit better, but were still far too high. A casual glance at these numbers could lead to the partially incorrect conclusion, that manipulation, when performed by a chiropractor, is much more dangerous than when performed by other practitioners. No, that would not be entirely correct. They should be seen more as a reflexion of the fact that manipulation is most often performed by DCs.

Regardless of who performs the manipulation - the more it gets done, the greater the risk. Sooner or later someone is going to get hurt. It needs to be used much more judiciously, by whoever it is that uses it, than most DCs use it today. If a PT or MD were to use spinal manipulation in precisely the same way, extent and frequency that DCs do, they would be exposing their patients to the same risks that chiropractic patients are exposed to every day. The statistics would then reveal more injuries from PTs and MDs.

While the technique itself is potentially problematic, the attitude of most chiropractors towards it makes it doubly so when applied by them.

Spinal manipulative therapy is an independent risk factor for vertebral artery dissection

Neurologic complications following chiropractic manipulation: a survey of California neurologists

Woman paralyzed by chiropractic neck manipulation

Chiropractic patient suffers stroke


Families Against Abusive Chiropractic Treatments (FAACT)

Diaphragmatic Paralysis Following Cervical Chiropractic Manipulation : Case Report and Review

Stroke victims five times more likely to have visited chiropractor

Horner's syndrome and dissection of the internal carotid artery after chiropractic manipulation of the neck.

Sudden neck movement and cervical artery dissection

Cervical manipulation: How risky is it?

Spontaneous vs Traumatic Arterial Dissection

"Chiropractors distort info negative to their practice" -- Sharon J. Mathiason (mother of a deceased victim)

Rand Finds Little Justification for Neck Manipulation

"A 1996 Rand report on The Appropriateness of Manipulation and Mobilization of the Cervical Spine (Coulter 1996) . . . concluded that only 11.1 percent of reported indications for cervical manipulation could be labeled appropriate. A patient who receives regular, frequent, and totally unnecessary neck manipulation is subjected to greater risk." -- Dr. Samuel Homola, DC., Skeptical Inquirer, Jan./Feb. 2001.

Complications of Cervical Manipulation

Deadly quacks: Neurologists have long protested the practice of 'highest neck manipulation,' which in some cases has resulted in lethal strokes

Chiropractic treatment of the neck can be a risk factor for stroke

Chiropractic Tied to Rare Strokes

Is chiropractic really complete garbage? I was under the impression it was a legit medical thing

What is worth knowing about the Chiropractic profession?


From a former chiropractor:

I have been doing a vascular surgery rotation for the past month, which is part of my postgraduate medical education. During my chiropractic training, when the subject of manipulation-induced stroke was brought up, we were reassured that "millions of chiropractic adjustments are made each year and only a few incidents of stroke have been reported following neck manipulation." I recently found that two of the patients on my vascular service that suffered a cerebrovascular accident (stroke) had undergone neck manipulation by a chiropractor, one the day that sympotms had begun and the other four days afterward. If indeed the incidence of stroke is rare, one M.D. would see a case of manipulation-induced CVA about every 10 years. But I believe I have seen two in the past month! I therefore urge my medical colleagues to question their patients regarding recent visits to a chiropractor/neck manipulation when confronted with patients that present with the neurologic symptoms of stroke. I also urge potential chiropractic patients to not allow their necks to be manipulated in any way. The risk-to-benefit ratio is much too high to warrant such a procedure.
-- Rob Alexander, M.D.



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