Chiropractic care is a complementary health approach focused on diagnosing and treating musculoskeletal disorders, especially those involving the spine. This practice often uses manual techniques like spinal adjustments to improve joint function and alleviate discomfort. While many find relief, concerns exist about the safety of neck adjustments and their potential connection to stroke. This article explores the available evidence to provide a balanced overview.
Understanding the Relationship Between Neck Adjustments and Stroke
Medical literature reports a rare association between cervical manipulation and vertebral artery dissection (VAD), a specific type of stroke. Major health organizations, including the American Heart Association, acknowledge this potential link and advise informing patients before cervical spine manipulation. A key debate is whether neck adjustments directly cause these dissections or if patients, already experiencing symptoms like neck pain from an ongoing dissection, seek chiropractic care.
While rare, VAD is a serious condition. Some studies suggest that patients under 45 who experience certain strokes are more likely to have visited a chiropractor within a week of the event, though this doesn’t establish causation. Other research indicates people may seek care for symptoms like headaches and neck pain that are already signs of an arterial dissection. The estimated frequency of a serious adverse event, such as stroke, following neck adjustment is very low, ranging from 1 per 1.3 million to 5.85 million adjustments.
How Vertebral Artery Dissection Occurs
Vertebral artery dissection (VAD) occurs when there is a tear in the inner lining of the vertebral artery, a blood vessel in the neck supplying blood to the brain. Blood enters the arterial wall, separating its layers and potentially forming a clot. These arteries run through the cervical spine, making them susceptible to stress from certain neck movements. If a clot travels to the brain or blood flow is obstructed, it can result in an ischemic stroke.
VAD can also occur spontaneously or from common activities like minor trauma, whiplash, sports injuries, or sudden neck movements such as coughing or looking up. This shows that while neck manipulation is an associated factor, it is not the only cause of VAD. The underlying mechanism is mechanical stress or stretching of the artery, which can lead to a tear.
Recognizing Risk Factors and Warning Signs
Certain pre-existing conditions increase susceptibility to vertebral artery dissection. These include connective tissue disorders like Ehlers-Danlos syndrome or Marfan syndrome, fibromuscular dysplasia, atherosclerosis, or high blood pressure. Individuals with a history of recent neck trauma or infection may also be at increased risk. Patients should discuss their full medical history with their healthcare provider, including any family history of vascular issues.
Recognizing the warning signs of VAD or stroke is important for timely medical intervention. Symptoms can include sudden, severe neck pain (distinct from musculoskeletal pain) and a new, unusually severe headache, often at the back of the head. Other signs may involve dizziness, vertigo, double vision, slurred speech, difficulty swallowing, or sudden numbness or weakness on one side of the body. These symptoms can appear immediately or be delayed for hours or days, and require immediate medical attention.
Prioritizing Patient Safety in Chiropractic Care
Ensuring patient safety in chiropractic care begins with a thorough pre-treatment consultation. Chiropractors should conduct a comprehensive review of the patient’s medical history, including past injuries, existing conditions, and medications. This discussion helps identify potential contraindications for specific adjustments, such as underlying vascular issues or bone weakening diseases. Patients should openly communicate all symptoms and concerns.
A physical and neurological assessment, and sometimes imaging studies, may be performed to evaluate the neck’s condition and rule out underlying risks. Chiropractors are expected to discuss the benefits and potential risks of proposed treatments, including neck manipulation, enabling patients to provide informed consent. Patients can also inquire about alternative treatment approaches if they have concerns about high-velocity neck adjustments. Open communication between patient and practitioner forms the foundation for safe and effective care.