Monday, December 28, 2015

Stroke From Chiropractic Adjustment? The Evidence Says No

More Evidence That Disputes The Accusation of Chiropractic Neck Manipulation Causing Vertebral Artery Dissection Stroke.

As long as I have been a chiropractic physician I’ve heard the stories. A patient suffering a stroke at the hands of a chiropractor. Whenever the major newspapers are having a slow news week, you’ll see an article about this subject rehashing the same old rhetoric. However the fear instilled in a patient from news stories and other biased sources is something the chiropractic physicians face weekly in practice. 

A recent study took a different approach comparing the risks of VBA stroke (vertebral basilar artery) of patients visiting a chiropractic physician and their primary care physician. Interestingly there was more of an association between VBA stroke with PCP visit vs a visit with the chiropractor. Furthermore, it was found that in 1/3 of the VBA stroke cases associated with the chiropractic visit, neck manipulation was not performed. The authors of the study concluded:

We found no significant association between exposure to chiropractic care and the risk of VBAstroke. We conclude that manipulation is an unlikely cause of VBA stroke. The positive association between PCP visits and VBA stroke is most likely due to patient decisions to seek care for the symptoms (headache and neck pain) of arterial dissection.1

From this study it seems that people are visiting their chiropractic or primary care physicians because of symptoms associated with having a stroke (headaches and neck pain as the artery is in the process of dissection) and not being caused as a result of something the chiropractic or primary care physician did.  

This study's findings correlate with previous studies by Cassidy et. al, that report very low risk of VBA stroke association with chiropractic neck manipulation supporting a higher level of safety for patients with neck pain and headaches. The media as well as other biased groups would have the general public believe otherwise.

As research is showing us there is less of a causal relationship between neck manipulation and stroke, rather an association of patients seeking treatment from their MD or DC with symptoms of a stroke presenting as neck pain, upper back pain and headaches. These patients are literally walking into the doctor's office with a dissecting VBA stroke in progress. 

Dr. Todd Narson


1. Chiropr Man Therap. 2015 Jun 16;23:19. doi: 10.1186/s12998-015-0063-x. eCollection 2015.
Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations.Kosloff TM1, Elton D1, Tao J2, Bannister WM2.

2. BMJ Case Rep. 2015 Nov 12;2015. pii: bcr2015212568. doi: 10.1136/bcr-2015-212568. Vertebral artery dissection in evolution found during chiropractic examination. Futch D1, Schneider MJ2, Murphy D3, Grayev A4.

3. J Manipulative Physiol Ther. 2011 Jan;34(1):15-22. doi: 10.1016/j.jmpt.2010.11.001.A population-based case-series of Ontario patients who develop a vertebrobasilar artery stroke after seeing a chiropractor. Choi S1, Boyle E, Côté P, Cassidy JD.

4. J Manipulative Physiol Ther. 2009 Feb;32(2 Suppl):S201-8. doi: 10.1016/j.jmpt.2008.11.020.
Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Cassidy JD1, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ.

5. J Manipulative Physiol Ther. 2009 Feb;32(2 Suppl):S194-200. doi: 10.1016/j.jmpt.2008.11.019.
Examining vertebrobasilar artery stroke in two Canadian provinces. Boyle E1, Côté P, Grier AR, Cassidy JD.

6. Spine J. 2002 Sep-Oct;2(5):334-42. Clinical perceptions of the risk of vertebral artery dissection after cervical manipulation: the effect of referral bias. Haldeman S1, Carey P, Townsend M, Papadopoulos C.

Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.

Friday, December 18, 2015

CONCUSSION - Increase Neck Strength To Reduce Risk of Concussion

Strengthen Your Neck – Reduce Your Risk For Concussion

With Will Smith’s new movie CONCUSSION coming out, parents concern for their children’s safety in high impact sports is growing. As their concern grows, fear grows in the NFL that this movie and the condition it’s named after could have serious impact on the sport of football and open up a can of liability worms that they wanted to keep covered up. But there is good news.

According to several studies, increasing the strength of your neck can reduce the risk of concussion. One study specifically states for every one pound increase in neck strength, odds of concussion decreased by 5% 1.   Concussion can occur from a direct blow to the head or due to a phenomenon called “contre-coup”.  A direct blow causing direct impact and inflammation or the contrecoup where the body takes a hit and the head lags behind the momentum-striking one side of the skull, then after momentum shifts the other way, the brain rebounds and strikes the other side of the skull.  

A direct blow is more obvious. A boxer strikes his opponent in the head causing the injury to the brain or a football player takes a direct blow to the head. However in the contrecoup, the concussion is less obvious to those unfamiliar. The athlete takes a blow to the body, the body suddenly changes direction while the head and neck lag behind. This is when the first brain-to-skull impact occurs. The brain strikes the inside of the head because the body just shifted direction and the brain is literally floating inside the skull. Then, as the momentum catches up to the change in motion, the brain strikes the opposite side of the skull as the whipping motion stops. This can occur when one player collides into the body another, it can happen if you slip and fall or if you get into a car accident.

Think about shaking a walnut in the shell. Every time the walnut hits the inside of the shell-think about your brain hitting the inside of your skull. With each strike, the brain gets bruised and inflamed. The more inflammation-the more damage.

Increased muscle strength plays an important role in slowing down the momentum of the head/neck caused by the impact trauma. Stronger necks = less severe concussion.  Why? Because the stronger the neck muscles are the more they resist the contrecoup whipping motion.  This is why evaluating neck strength should be a part of every child’s pre-season assessment and neck strengthening should be part of every coach’s pre-season strength and conditioning program.

The question is, how do you strengthen your neck? There are numerous ways. First, get an examination of the neck to make sure it is stable and there are no underlying issues. Next, complete a baseline SCAT (Sports Concussion Assessment Tool) evaluation. It’s important to have a SCAT completed pre-season in case  a concussion occurs during the season, there is a baseline to compare it to so the athletic trainer or team physician can make appropriate decisions on the athlete's behalf.

In my opinion, neck strengthening should consist of base strength (just get those muscles strong) and functional strength. Functional strength is increasing muscle strength and coordination in such a way as those muscles are used in real life.  These are programs I do with my athlete patients as well as those patients with post whiplash trauma, recovering from neck surgery rehab patients and anyone suffering from the effects of herniated or bulging discs. Neck strength and stability can go a long way to aid your recovery. And, in light of recent research, to help mitigate the effects of a concussion.

Feel free to contact me to discuss a neck strengthening program that’s right for you.

Dr. Todd Narson
Diplomate of the American Chiropractic Board of Sports Physicians


1.     Neck strength: a protective factor reducing risk for concussion in high school sports. Collins CL, Fletcher EN, Fields SK, Kluchurosky L, Rohrkemper MK, Comstock RD, Cantu RC. J Prim Prev. 2014 Oct;35(5):309-19. doi: 10.1007/s10935-014-0355-2.

2.     The influence of cervical muscle characteristics on head impact biomechanics in football. Schmidt JD, Guskiewicz KM, Blackburn JT, Mihalik JP, Siegmund GP, Marshall SW. Am J Sports Med. 2014 Sep;42(9):2056-66. doi: 10.1177/0363546514536685. Epub 2014 Jun 13.

3.     Effect of neck muscle strength and anticipatory cervical muscle activation on the kinematic response of the head to impulsive loads. Eckner JT, Oh YK, Joshi MS, Richardson JK, Ashton-Miller JA. Am J Sports Med. 2014 Mar;42(3):566-76. doi: 10.1177/0363546513517869. Epub 2014 Jan 31.

4.     What are the most effective risk-reduction strategies in sportconcussion?Benson BW, McIntosh AS, Maddocks D, Herring SA, Raftery M, Dvorák J. Br J Sports Med. 2013 Apr;47(5):321-6. doi: 10.1136/bjsports-2013-092216. Review


Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.

Friday, December 11, 2015

5 Steps To Surviving The Holidays Without Busting Your Belt!

I want you to know you can survive the holiday season without missing out –AND- not messing up your healthy eating game plan.

Guilt can be a strong emotion. Ultimately, in one form or another you will succumb to the guilt. So why not plan for it rather than be controlled by it? It’s ok to eat a food you desire as long as it’s not being done regularly. When you do something on a regular basis (sit on the couch, exercise, eat poorly, eat healthfully) you are telling your body to adapt to whatever it is that you are doing do it regularly. This can be good or it can be bad.  So if you don’t make it a regular thing, you may be able to enjoy some holiday fare and not bust your belt and have to start from scratch on January 1st.

There’s no reason you can’t enjoy whatever you desire to eat at a holiday party. That is, as long as you don’t have an allergy, food sensitivity or autoimmunity to it-or you are diabetic. If that’s the case, well, you know your limits-deal with it. You know the consequences. But otherwise, you’ve worked hard to improve and maintain your health so here are my 5 tips on how to survive the holiday parties with your belt, waistline and health intact.
So here we go:

1.      Eat before you go.  I know going out to a holiday party is all about the food, the friends and the fun.  And trust me; there will be plenty of food there. However if your blood sugar is on an even keel, then you don’t have to worry about being so hungry when you get there that you devour everything in your way. Eat some good protein and healthy fats before you go and you’ll get a long term benefit that allows you to pick and choose your party food without being ruled by your hormones!  You remember how hormones ruled you as a teenager, although these are different hormones, they’re just as powerful.

2.      Fiber filled foods fill you up; Fiber filled foods such as carrot sticks can fill you up fast and last quite a while as your gut takes the time to break them down. When you arrive at the party and you’re still satisfied from eating before you left the house, start with some veggies to maintain what you started at home.
3.      Protein packs a punch; No doubt, there will be cocktail shrimp, turkey, ham, roast beef, chicken, etc. Those with allergies and sensitivities please be careful with the sauces and dips (know your ingredients). But protein packs a punch of calories and having a few ounces every couple hours will go a long way in keeping your blood sugar even and your hormones at bay.

4.      Think before you drink; if you have food allergies, sensitivities or auto-immunities, then make sure you know what was fermented to make your drink of choice. Moonshine most often comes from corn, Vodka from potatoes, beer has gluten grains, wine is from grapes and so on…Choose wisely. Don't drink and drive. 

5.      Your just desserts!  Desserts. Ah, the best for last and probably the reason you’re reading this post. Other than ingredients that may play on you food sensitivities, allergies and auto-immunities, realize it has sugar and is gonna taste fantastic. Eating dessert for some people isthe party. Look over those desserts, choose the 1 or 2 items that for you are totally over the top and remember that this is one of the reasons you eat healthfully and workout like a fiend. Don’t feel guilty, just enjoy it. The fact that you’ve planned it and that you’ve kept your blood sugar steady means you (hopefully) won’t overdo it when it comes to desserts.   

Guilt causes stress and stress (for the most part) is bad. So if you’re gonna eat something to satisfy your taste buds, just get back on track with your next meal and hit the gym the next morning. You’ll be back on track without missing a stride like nothing ever happened.

Oh, when you're at the party, talk to someone. Get into a conversation. As you do, you'll engage your brain into something other than the food. Hey, that's really why we're there anyway, isn't it?

Happy Hanukkah, Merry Christmas & Happy New Year.  And, for those special folks, Happy Festivus! 

Yours in Health,

Dr. Todd M Narson
·         Diplomate of the American Chiropractic Board of Sports Physician
·         USA Triathlon Certified Coach

Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. Dr. Narson is an active triathlete and triathlon coach. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.