Is there a connection between stroke and chiropractic treatment?
Would you think twice about cradling the phone on your shoulder, checking your blind spot while backing into a parking space or getting your hair shampooed at a salon? The risk of stroke from chiropractic care is no greater than it is from any of these everyday activities.

The source of public concern in this regard is a condition known as vertebral artery syndrome (VAS), which occurs when sudden head movements disrupt the blood flow in the vertebral artery, possibly leading to stroke. As the above examples illustrate, the risk of this complication arising from upper cervical (or neck) manipulation by a chiropractor is extremely remote. According to the 1996 RAND report, "The Appropriateness of Manipulation and Mobilization of the Cervical Spine," only one out of every one million chiropractic patients experiences VAS. Other analysis of studies over the last several decades put the risk at between one in a million and one and five million adjustments. To put it another way, you are five to twenty-five times more likely to get hit by lightning than to suffer VAS at the hands of a chiropractor.

Chiropractic is the safest of all types of medical care. Insurance carriers that provide malpractice coverage keep very close statistics on the risk to people receiving different medical procedures. The insurance companies then “rate” the amount of risk that different medical specialties and procedures have for people receiving that form of care. They then charge the doctors that put people at the highest risk the highest premiums. Chiropractors pay by far the lowest premiums for malpractice insurance of any type of medical provider. In fact, most chiropractors pay less for malpractice coverage than the average person pays for automobile insurance.

Up to 75% of chiropractic patients receive cervical manipulation as part of their individual chiropractic care. It may be performed as part of your care for total spinal health and wellness, or for specific causes such as muscle tension and stiffness, headache or injury. After a detailed history and examination, if there is any indication that you would be at risk, your chiropractor will not include a neck adjustment in your treatment.

How does the safety of chiropractic compare to other medical procedures?
In comparison to allopathic medicine, which uses drugs and surgery as an integral part of treatment, chiropractic presents far less risk. Consider, for example, that in the United States an estimated 140,000 people die each year from drug-related reactions. And the risk of death due to gastrointestinal complications from taking nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen is 400 times greater that the complication rate for people who receive cervical manipulation, while the mortality rate for people who undergo cervical spine surgery is 7,000 times higher.

Human error is another factor that tilts the safety balance in chiropractic's favor. In the United States, it is estimated that up to 98,000 Americans die yearly from medical errors -- a doctor accidentally making the wrong incision, a nurse administering the wrong medication, and so on.

But with all forms of treatment, whether allopathic or alternative, any risks, however slight, should not be ignored. While the methods used by chiropractors have proven to be safe in almost all cases, it is a constant concern for chiropractors to evaluate their patients to determine if treatment will cause an adverse reaction.

Can chiropractic adjustment damage your joints?
The answer is no. In fact the evidence shows clearly that chiropractic manipulation can actually prevent arthritis. It does this by restoring the proper motion to the joint. Medical textbooks will tell you that it is loss of motion of a joint that causes damage and arthritis to the joint. Restoring proper function to the joint provides the cartilage and disc (in the case of the spine), with improved blood supply. Better blood supply means better nourishment and the ability to dispose of waste products. What's more, most chiropractic adjustments are painless. Often, the adjustment may feel good and can provide immediate relief from stiffness or tension.

What makes the "crackling noise" when an adjustment is delivered?
While some people may get nervous about the "pop" that an adjustment can produce, the sound is not coming from the bones themselves. It's coming from a lubricant called synovial fluid that's found in every joint. That fluid contains dissolved gases. Shifting the joint with an adjustment into proper motion and alignment releases the built up pressure that has resulted from the joint being subluxated. This causes a shifting of the fluid and gasses in the joint to make a crackling noise.

Are adjustments painful?
Most chiropractic adjustments are painless; in fact, the adjustment may feel good and can be relieving. If you've had a recent injury, however, adjustments can irritate inflamed tissue and cause some discomfort. Using ice after any irritation is recommended. Some people also experience odd sensations in their muscles or extremities after adjustments. This is a normal reaction to the relieving of pressure on nerves and is usually no cause for concern. It is thought by some scientists to be an increase in circulation once the irritation is removed from the nerve.

Can chiropractic adjustment lead to arthritis?
There is no evidence to suggest that chiropractic care and manipulation of the spine can lead to arthritis. On the contrary, chiropractors often care for people with arthritis by maintaining joint health. Motion is life when it comes to joint health.

Is it safe to adjust myself?
Concern has been raised over the safety of people who try to adjust themselves, by cracking their own knuckles, for example. While people might have the right idea by trying to relieve pressure on the joints, only chiropractors can ensure an adjustment is performed safely, and in the right direction without possibly weakening or causing harmful friction to surrounding joint structures. The best advice: Don't try to do it yourself. Seek the expertise of your chiropractor.

Do chiropractors refer patients to other specialists?
Like other doctors, chiropractors belong to a large and growing network of health-care professionals and make referrals for patients when necessary. Chiropractors are well educated to recognize risk factors and signs of disease and will not hesitate to make a referral when it's in a patient's best interest.

References

Zuber, M., J. Meder and J. Moss. "Cartoid Artery Dissection due to Elongated Styloid Process." Neurology (Nov. 1999).

U.S. Department of Health and Human Services. "Chiropractic in the United States: Training, Practice and Research," Dec. 1997.

Coulter, I., E. Hurwitz, A. Adams, W. Meeker, D. Hansen, R. Mootz, P. Aker, B. Genovese and P. Shekelle. "The Appropriateness of Manipulation and Mobilization of the Cervical Spine." Santa Monica: RAND, 1996.

Shekelle, P. G., E. Hurwitz, I. Coulter, A. Adams, B. Genovese and R. Brook. "The Appropriateness of Chiropractic Spinal Manipulation for Low-Back Pain." Santa Monica: RAND, 1996.

Dabbs, V. and W. Lauretti. "A Risk Assessment of Cervical Manipulation v. NSAIDs for the Treatment of Neck Pain." Journal of Manipulative and Physiological Therapeutics, Vol. 18 (1995): 530-36.
Carson, J.L. and L.R. Willett. "Toxicity of Nonsteroidal Anti-inflammatory drugs: An Overview of the Epidemiological Evidence." Drugs, Vol. 46 (1993): 243-248.

Weintrob, M. "Beauty Parlor Stroke Syndrome: Report of Five Cases." Journal of the American Medical Association (1993): 2085-86.

Manga, Pran, D. Angus, et al. "The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain." Ottawa: University of Ottawa, 1993.

Gabriel, S.E., L. Jaakkimainen and C. Bombardier. "Risk for Serious Gastrointestinal Gomplications Related to the Use of Nonsteroidal Anti-inflammatory Drugs: A Meta Analysis." Annals of Internal Medicine, Vol. 115 (1991): 787-796.

Hasselberg, P.D., Report of the Commission of Inquiry. "Chiropractic in New Zealand." Wellington, 1979.