American Heart Association's Stroke Statement
Written by Editor   
Tuesday, August 19, 2014 04:01 PM

The American Heart Association warned that patients should be warned before chiropractic manipulation of the neck that the technique has been linked to cervical dissection, which can cause stroke.  In the October issue of the AHA's publication Stroke they cautioned about the low level of evidence for a connection.  The current biomechanical evidence is insufficient to establish any causal claim, the statement noted.

The Palmer Center for Chiropractic Research warns about the American Heart Association's statement being misleading regarding strokes and chiropractic.

"Although the incidence of cervical dissection in cervical manipulative therapy patients is probably low, and causality difficult to prove, practitioners should both strongly consider the possibility of cervical dissection and inform patients of the statistical association between cervical dissection and cervical manipulative therapy, prior to performing manipulation of the cervical spine,"

Part of the concern is that "patients with vertebral artery dissection commonly present with neck pain, which may not be diagnosed prior to any cervical manipulative therapy.  Because patients with vertebral artery dissection commonly present with neck pain, it is possible that they seek therapy for this symptom from providers, including cervical manipulaticurrent biomechanical evidence is insufficient to establish any causal claim, the statement noted.


According to the Palmer Center for Chiropractic Research, the world’s largest chiropractic research center, the statement strongly implies a causal relationship between chiropractic manipulative therapy and stroke — which isn’t substantiated by the best research available.

Christine Goertz, DC, PhD, vice chancellor for research and health policy at Palmer College of Chiropractic, explained that medical doctors and doctors of chiropractic need to be vigilant in assessing patients who may be in the early stages of vertebral arterial dissection (VAD). It’s also extremely important that the data regarding the risk of VAD is presented to patients in an accurate manner.

“The facts are that VADs are very, very rare events, and there’s absolutely no research that shows a cause-and-effect relationship between chiropractic care and stroke,” Goertz said. “Doctors need to be careful about how they counsel patients based on misleading statements, like this one from the American Heart Association.”

A video clip of Goertz providing analysis and context about the AHA statement is online at

The Palmer Center for Chiropractic Research (PCCR) is the largest and most highly funded chiropractic research center in the world. Since 1995, the PCCR has received more than $35 million in grants from sources like the National Institutes of Health, the U.S. Health Resources and Services Administration and the Department of Defense.


The American Chiropractic Association (ACA) President Anthony Hamm, DC, issued the following comment today in response:  “The chiropractic profession shares the American Heart Association’s public health goal to reduce the number of strokes; however we have concerns about its statement on cervical manipulative therapy. The real message to all healthcare providers attending to patients with headaches or neck pain is to be vigilant for neurological problems that could be the early signs of stroke.

The largest and most credible study, Cassidy et al., found that a patient is as likely to have seen a primary care medical doctor as a doctor of chiropractic prior to experiencing a cervical arterial dissection (CD).

Neck manipulation is a safe, conservative treatment option for neck pain and headache. The evidence presented in the AHA paper fails to show that neck manipulation is a significant risk factor in CD. In addition, the paper fails to put into context risks associated with other neck pain treatments such as neck surgery, steroid injections and prescription drugs.

DCs are trained to perform a complete examination, develop a diagnosis and treatment plan, and provide informed consent. ACA members are committed to mitigate the low incidence of CD through education initiatives.”