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.

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