Concerns surrounding the safety of neck adjustments, particularly chiropractic manipulations, and their potential link to stroke are prevalent. While such events are rare, the seriousness of a stroke warrants a clear understanding of this potential association.
How Neck Adjustments Can Lead to Stroke
Neck adjustments, often performed in chiropractic care, involve precise movements to the cervical spine. In rare instances, these manipulations can lead to vertebral artery dissection. The vertebral arteries are major blood vessels located at the back of the neck, supplying blood to the brain.
A dissection occurs when there is a tear in the inner lining of an artery wall. This tear allows blood to enter the arterial wall, forming a clot or hematoma within the vessel. Pieces of this clot can then break off and travel to the brain, or the expanding clot can narrow the vessel, impeding blood flow. This disruption of blood supply to the brain can result in an ischemic stroke.
The mechanism involves rapid, high-velocity thrusts used in cervical manipulations, which can place strain on these vessels. While vertebral arteries are resilient, certain movements, especially those involving rapid rotation, may stretch the artery and potentially cause a tear in susceptible individuals.
Understanding the Risk
Stroke following neck adjustments is considered a rare occurrence. Estimates of serious adverse events like stroke range from approximately 0.05 to 1.46 per 10,000,000 manipulations. Other reports suggest an incidence of around 1 in 20,000 spinal manipulations leading to vertebral artery dissection and ischemic stroke, though the exact incidence is not definitively known. Some studies indicate that a chiropractor might encounter an arterial dissection following cervical manipulation only once in 8.06 million office visits.
The association between neck adjustments and stroke is a complex topic. Some research suggests the relationship may be coincidental rather than causal. Patients experiencing early stages of a vertebral artery dissection may present with neck pain or headaches, leading them to seek chiropractic care. In such cases, the adjustment might occur when an underlying dissection is already present, making it appear as though the adjustment caused the stroke.
Certain factors can increase an individual’s predisposition to arterial dissection, including underlying connective tissue disorders, hypertension, recent infections, or pre-existing vessel abnormalities. However, dissections can also occur spontaneously or due to other minor traumas like car accidents, sports, or even everyday activities such as talking on the telephone or stargazing.
Recognizing Signs and Seeking Immediate Help
Recognizing the signs of a stroke and seeking immediate medical attention is important, especially after a neck adjustment. Stroke symptoms can appear immediately or even hours to weeks after an arterial injury. The F.A.S.T. acronym is a tool to help identify common stroke signs.
- Face drooping (one side of the face droops or feels numb)
- Arm weakness (one arm is weak or numb, or drifts downward when raised)
- Speech difficulty (speech is slurred, or the person is unable to speak or hard to understand)
- Time to call emergency services
Other symptoms can include sudden numbness or weakness on one side of the body, difficulty finding words, sudden blurred vision, dizziness, unsteadiness, or a sudden, severe headache.
If any of these symptoms appear after a neck adjustment, call emergency services immediately. Prompt medical attention improves the chances of survival and successful recovery, as the sooner treatment begins, the lower the risk of permanent brain damage.
Patient and Practitioner Safety Measures
To minimize potential risks associated with neck adjustments, both patients and practitioners can take proactive steps. Patients should provide a thorough medical history, including any pre-existing conditions, recent injuries, or unusual symptoms like neck pain or headaches. Disclosing all relevant health information allows the practitioner to make informed decisions about the appropriateness of a neck adjustment.
For practitioners, comprehensive patient screening is a safety measure. This typically involves a detailed medical history review, a physical examination to assess range of motion and muscle tension, and, in some cases, imaging studies to understand the neck’s structural alignment. Practitioners are trained to identify potential contraindications or risk factors, such as vascular issues or specific conditions that might make high-velocity manipulation risky.
Utilizing careful assessment and appropriate techniques, including gentler methods like the Activator Method or soft mobilization, can also contribute to patient safety. If there are any concerns or red flags, a responsible practitioner may recommend alternative therapies or refer the patient for further medical evaluation.