News & Information
Internal Forces Sustained by the Vertebral Artery During Spinal Manipulative Therapy.
Written by Editor   
Wednesday, April 30, 2014 12:23 PM

Spinal manipulative therapy (SMT) has been established as a clinically effective modality for the management of several musculoskeletal disorders. One major issue with the use of SMT is its safety, especially with respect to neck manipulation and the risk of stroke in the vertebrobasilar system.  The authors of this study conclude that SMT resulted in strains to the VA that were almost an order of magnitude lower than the strains required to mechanically disrupt it. We conclude that under normal circumstances, a single typical (high-velocity/low-amplitude) SMT thrust is very unlikely to mechanically disrupt the VA.

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Symptomatic Reactions, Clinical Outcomes and Patient Satisfaction
Written by Editor   
Wednesday, April 30, 2014 12:15 PM

Observational studies have previously shown that adverse events following manipulation to the neck and/or back are relatively common, although these reactions tend to be mild in intensity and self-limiting. Upper cervical chiropractic care may have a fairly common occurrence of mild intensity SRs short in duration (<24 hours), and rarely severe in intensity; however, outcome assessments were significantly improved with less than 3 weeks of care with a high level of patient satisfaction. However, no prospective study has examined the incidence of adverse reactions following spinal adjustments using upper cervical techniques, and the impact of this care on clinical outcomes. 

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Assessing the Risk of Stroke from Neck Manipulation: A Systematic Review.
Written by Editor   
Wednesday, April 30, 2014 11:55 AM

Strokes, typically involving vertebral artery dissection, can follow cervical spinal manipulative therapy, and these types of stroke occur rarely. There is disagreement about whether a strong association between neck manipulation and stroke exists, but conclusive evidence is lacking for a strong association between neck manipulation and stroke.

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The Association Between Cervical Spine Manipulation and Carotid Artery Dissection: A Systematic Review of the Literature.
Written by Editor   
Wednesday, April 30, 2014 11:51 AM

Controversy surrounds the safety of cervical spine manipulation. Ischemic stroke secondary to cervical spine manipulation is a hypothesized adverse event. The primary objective of this study was to determine the incidence of internal carotid artery (ICA) dissection after cervical spine manipulation in patients who experience neck pain and its associated disorders. The secondary objective was to determine whether cervical spine manipulation is associated with an increased risk of ICA dissection in patients with neck pain, upper back pain, or headaches.

We systematically searched MEDLINE, CINAHL, Alternative Health, AMED, Index to Chiropractic Literature, and EMBASE from 1970 to November 2012. Two independent reviewers used standardized criteria to screen the eligibility of articles. We considered cohort studies, case-control studies, and randomized clinical trials that addressed our objectives.

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Current Understanding of the relationship Between Cervical Manipulation and Stroke
Written by Editor   
Wednesday, April 30, 2014 11:25 AM

The understanding of the relationship between cervical manipulative therapy (CMT) and vertebral artery dissection and stroke (VADS) has evolved considerably over the years. In the beginning the relationship was seen as simple cause-effect, in which CMT was seen to cause VADS in certain susceptible individuals. This was perceived as extremely rare by chiropractic physicians, but as far more common by neurologists and others. Recent evidence has clarified the relationship considerably, and suggests that the relationship is not causal, but that patients with VADS often have initial symptoms which cause them to seek care from a chiropractic physician and have a stroke some time after, independent of the chiropractic visit.

This new understanding has shifted the focus for the chiropractic physician from one of attempting to "screen" for "risk of complication to manipulation" to one of recognizing the patient who may be having VADS so that early diagnosis and intervention can be pursued. In addition, this new understanding presents the chiropractic profession with an opportunity to change the conversation about CMT and VADS by taking a proactive, public health approach to this uncommon but potentially devastating disorder.

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