Manual Chiropractic Adjustment Does Not Increase Cervical Arterial Dissection Risk
According to the American Chiropractic Association, chiropractic professionals across the country treat an estimated 35 million Americans each year. But while the general public has accepted that chiropractic treatment can provide substantial relief for a number of conditions, the ACA also notes that there are also some widely held beliefs about the relationship between these treatments and certain adverse physical events that patients might experience.
For example, the occurrence of a cervical arterial dissection (or CAD) -- a tear in the vertebral artery or internal carotid -- may be followed by an intramural hematoma and/or an aneurysmal dilatation. In other words, this tear may be accompanied by a stroke. Even though this condition is believed to occur spontaneously, there's a pervasive theory that the types of cervical manipulation performed by professional chiropractors or physicians could increase the risk of a cervical arterial dissection. Anecdotally speaking, physical neck trauma (particularly as it relates to rotation or hyperextension) has been reported to be a trigger in some cases. Understandably, this has some patients worried and asking “is chiropractic treatment safe” or if a visit to their chiropractic professional could result in a catastrophic and potentially deadly event.
However, the research simply does not support this chiropractic myth. According to a recent risk-benefit assessment of this very issue, the reality is that there is currently no research that can definitively say that treatment performed by chiropractic professionals contributes to vertebral artery dissection. Because cervical arterial dissection is such a rare condition, it's extremely difficult to study. What's more, it's just as likely that patients who are experiencing early symptoms of CAD (which often include headache and neck pain) seek out treatment from a local chiropractic professional, only to discover later that this condition is a factor in their lives and is the underlying cause of their pain and discomfort.
The ACA explains: "Historically, opinion rather than fact has often dominated discussions on this topic, even though the incidence of stroke associated with cervical manipulation is very rare and there is a lack of evidence to prove that cervical adjustments cause stroke. ACA is sensitive to the public’s concerns surrounding this complex issue, and is offering the following resources to help doctors of chiropractic disseminate accurate information to patients, health care colleagues and the media."
There are certainly questions about whether chiropractic treatment is safe and if it could potentially worsen CAD already in progress. But the best way to prevent cervical dissection, whether you're at your chiropractor's office or have made an appointment with your regular physician, is to ensure your doctor partakes in excellent record-keeping and discusses your medical history thoroughly with you during your visit. The more your doctor knows about you, your pain, and other risk factors in your life, the better equipped they will be to treat you properly.
As the assessment notes, "It is paramount that all clinicians, especially manual therapists who utilize cervical mobilization and/or manipulation techniques, are well informed of the possible red flags and are capable of referring patients to essential medical examinations and treatments (anticoagulants or antiplatelet drugs) before initiating manual-therapy interventions, as recommended by the American Heart and Stroke Association."
Of course, it's always a good idea to proceed with caution when receiving any type of treatment -- whether it be a prescribed medication or a manual adjustment. But the World Health Organization considers manual mobilization and manipulation to be safe and effective when performed by professional chiropractors. For patients who have concerns about CAD, it's recommended that you speak with your doctor about those health worries and to ensure your chiropractor understands the symptoms of CAD and how to proceed when it's suspected that a patient might need further examination. Ultimately, the risk of manual cervical adjustments do not carry a higher risk of a patient developing CAD -- but it's always good to err on the side of caution with your physical health.
