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A Kink in Chiropractic: No One Knows Why Neck Manipulation May Lead to Stroke

Posted on: 11/30/1999
The use of manipulation or mobilization of the neck (sometimes called an "adjustment") seems to help with some conditions. In fact, more and more studies have agreed that spine manipulation gives relief from pain and increases neck motion. This is especially true for people with neck pain, tension headaches, and whiplash injuries.

The increased use of this technique raises some questions. One concern is the possibility of a stroke after manipulation of the neck. How often does this really happen? Who is at risk? If risk factors can be determined, then patients can be screened ahead of time and advised of the possible dangers.

Risk factors may include age, gender, high blood pressure, diabetes, birth control pills, smoking, and migraine headaches. These are all thought to be risks, but no one has been able to clearly link them with stroke after manipulation. Likewise, patients are tested for problems with the neck arteries before manipulation, but no one has proven that this screening is accurate or effective.

One group of physicians and chiropractors reviewed 64 cases of strokes caused by neck manipulation. They were looking for common patterns among the patients that would point to one or more specific risk factors. Each of these cases was being investigated legally. For this reason, the medical and chiropractic records were thought to be very complete.

According to this study, strokes after neck manipulation are rare and unpredictable. No clear risk factors were found. Although most strokes occurred in patients between the ages of 30 and 50, this age group was more likely to go to a chiropractor for treatment in the first place. There was no evidence that older adults at risk for stroke from age or other medical conditions were more likely to have this problem after neck manipulation.

Right now, it isn't possible to predict who might have a stroke after neck manipulation. The risk of complications from neck manipulation is not any higher than the risk that goes along with other common treatments for neck pain.

Scott Haldeman, MD, PhD, et al. Unpredictability of Cerebrovascular Ischemia Associated With Cervical Spine Manipulation Therapy. In Spine. January 1, 2002. Vol. 27. No. 1. Pp. 49-55.

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