“Hey doc, last weekend I had dinner with a friend who’s cousin’s half brother is a nurse in an ER and he was telling us that Chiropractors cause stroke. Is that true?”
“No, it’s not true.”
Yes, we are a profession built on human skill and connection and humans can make mistakes. We’re not all perfect and it does bring up horrible feelings in me when someone goes to a Chiropractor, receives a bad adjustment, and feels worse off then when they began. Or worse, a couple of days later ends up in the ER with a stroke. But Chiropractic and the Chiropractor did not cause that stroke. Chiropractic as a cause of stroke was dis-proven years ago. Yet, we still have patients ask us if Chiropractic can cause a stroke.
For starters this has been a favorite knock on Chiropractic by the medical profession for at least 40 years. It comes up every five to ten years, usually by a neurologist. Most medical doctors accept the evidence that Chiropractic is safe, so please don’t think they’re all against Chiropractic. Many Medical Doctors appreciate and utilize Chiropractic for themselves and their families.
Research Proves Chiropractic Does Not Cause Stroke
Dr. David Cassidy has produced 2 studies researching Chiropractic care and stroke. The first had to do with stroke due to Vertebral Artery Dissection (more on that in a moment); the second with Carotid Artery Stroke. Their abstracts can be read here and here. Both studies conclude, “there is no increased risk of stroke after Chiropractic care.” In both studies, the risk was the same for those who sought care from a Chiropractor and a Primary Care Physician. In fact, you are as likely to have a stroke due to a Chiropractic adjustment as you are your MD’s procedures, a yoga studio, a hairdresser, or going on a neighborhood walk. In other words, either Chiropractic has no correlation to stroke. Either that or we all need additional insurance against a stroke for that nightly neighborhood walk.
Provided below is a list of other research articles (“White papers”) that provide the same results. Click on the title to read their abstracts:
Safety of chiropractic interventions: a systematic review.
Stroke, cerebral artery dissection, and cervical spine manipulation therapy.
Safety of chiropractic manipulation of the cervical spine: a prospective national survey.
Torque and Force
Those who have never seen or received a Chiropractic Adjustment state they are harmful because of “violent forces.” Violent forces are what you see in the movies when the bad guy twists the head of someone and they collapse to the floor. This same force is used to describe the force needed to tear an artery of the neck (see link in “Arteries” below). That force is called torque and is measured in Pounds per Square Inch (PSI). The bones of the spine can withstand 75 PSI of torque before failure (negative impact).
As part of my personal training I’ve delivered adjustments on tools that measure this force. The highest I’ve ever measured is 25 PSI and the lowest to still deliver an adjustment is 3 PSI. Typically I’m in the single digits. Given the failure point of a vertebrae is 75 PSI, there is plenty of room to go stronger. But less is more; so, why would I?
Many Chiropractors utilize this technology as part of their training when learning how to adjust or while at Continue Education seminars that incorporate adjusting techniques.
Adjustment vs. Manipulation
The purpose of an adjustment is to unite man the physical with man the spiritual. It’s about releasing the energy of life into the body. It’s about inserting a force into the body and allowing the body do what it knows it needs to. Namely, heal itself. With this in mind, it is better to use as little force as necessary to illicit A response. Your body knows what it needs far better than anyone outside of you.
The purpose of a manipulation is to improve Range of Motion and decrease pain. That’s it. Even if it means applying more force, at all costs, fulfill the purpose when delivering a manipulation.
Decreasing pain isn’t always a good thing because its a false sense of security. When you have a back pain and it is decreased, you think you are ok to go out and do what you would normally do everyday. Then you relapse or cause more and greater damage. When, had the pain been there in the first place, you would have been more cautious and protective.
Rotational Movements
Those who claim Chiropractic causes stroke are also concerned with the “twisting” motion of a manipulation. And yes, in a strictly rotational (twist) motion, damage can occur (we call them “rotary breaks” for a reason). In fact, when a Chiropractor provides a strict rotational manipulation, I would say damage is possible in the hands of someone of lesser skill. These Chiropractors are few and far between. If it were happening anywhere with any frequency it would be at Chiropractic colleges when we are all learning the (and at the time commonly have “lesser”) skills necessary for our career. We practice on each other and all make it out unscathed.
Coming back to my PSI statements above, the average Chiropractor provides 25 PSI per impulse in this situation. That’s still a long ways from 75 PSI to completely tear an artery (more in “Arteries” below).
Moreover, when Chiropractors adjust patients face up (laying on their backs) we add in the necessary safety precautions (head and neck positioning) and remove the rotation movement in question. In other words, a competent Chiropractor adjusts without rotational movements.
Vertebral Arteries
When people talk about Chiropractic causing stroke, they most commonly refer to the vertebral arteries. These arteries run right along the side of the spine and serve about 10% of the brain’s blood flow. The carotid artery serves the major 90% of the blood to the brain. Such people think that adjustments can tear the arteries. However, it takes a massive amount of trauma to do so. Greg W Self, Specialist Vascular Surgeon, Southern Vascular Clinic (Melbourne, Australia) states:
You could not tear an artery in the neck totally through unless you actually torn the person’s head off…
I have not heard of it being due to coughing alone but suppose it could occur. One suspects that the artery may have had prior damage from hypertension, hypercholesterolaemia, diabetes, etc, to dissect after a coughing fit.
As the surgeon’s comments state, a tear can occur from a cough, supposing the artery “had prior damage from hypertension, hypercholesterolaemia, diabetes, etc…” This is why it is important for you to inform your chiropractor of any vascular situation that you or a family member may have. It helps us asses your risk. If you are higher risk, a competent Chiropractor will utilize a corresponding adjusting technique such as drop table adjustments (3 PSI) or an adjusting tool (such as an Activator) that will lighten the force.
Carotid Arteries
Even the carotid artery, which is the current soup du jour of the Chiropractic strokers is difficult to tear in a live person. They often cite cadaver studies where the carotid artery is easily severed. Well, yeah, its a cadaver, its brittle, tightened, and decaying. In a live person there is a great amount of slack in a person’s carotid artery to allow for rotational movement of the head and still supply blood to the brain. Ever seen a martial artist or a boxer take a shot to the side of the head? No stroke argument there, only with Chiropractic is stroke even brought up. All of the movement statements made above also apply here.
Malpractice Insurance Premiums
Chiropractors have the lowest Malpractice Premiums of any profession on the planet. My malpractice premiums are less than my accountant’s. Why do you think that is?
Detractors will say that it’s because we combine all of our visits and procedures and that’s why our insurances are so low. I say, yeah, exactly, thank you for helping make my point.
There are over 1 million neck adjustments provided per day in the USA. Insurance carriers know their actuarial tables (how they determine their risk of exposure). If Chiropractors were causing stroke at any rate above or beyond coincidental involvement, Chiropractors would be paying for that risk.
In Conclusion
People talk and tell many stories. Humans like the attention and prestige awarded someone who has a sensational story to tell. When you hear the words “Chiropractic” and “stroke” in the same sentence, realize its all gossip filled with personal interjections and zero basis in fact with regards to Chiropractic and stroke.
Please, please, pay attention to them, because you are about to hear a truly heartbreaking story from someone who may need comforting. Remember that they are human and so is the person who suffered the stroke. Care for the person first; points of fact such as those above can be introduced at a later time.
Thank you for taking the time to read this article and learning about Chiropractic and Stroke. SHould you ahve any questions, we can be reached via email at drbrian@nardifamilychiropractic.com
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