Please Read if Visit or Plan to Visit a Chiropractor

[numbere]

My brother in law, who's 43 and arguably in better shape than I, recently had a stroke while working out with a trainer.

His Neurologist linked the stroke to a recent neck manipulation by a Chiropractor which bruised his vertebral artery.

Chiropractic neck adjustments are the leading cause of stroke in people under 50.

Chiropractic's Dirty Secret:
Neck Manipulation and Strokes

There's a ton of information on this topic but Dr Barrett does a great job of summarizing everything in the link above.

This might be old news to some of you but I just wanted to share this with those who are not aware.

[Proximal]

Have been adjusted by a chiropractor once after I couldn't "pop" my own vertebra. It is aggressive and this doesn't surprise me.

[RaginCajun]

Damn

Same thing happened to some model chick

[MuscleScience]

I'm sorry to hear that about your brother in law. I hope for a speedy recover!

The risk of cervical manipulative therapy to cause an otherwise healthy individual to have a stroke has been establish by independent research to be not causal in nature. Im not saying it can't happen obviously, but it's a astronomical low risk. I think people should be aware of the association (informed consent) but I don't think one can make a statement like Dr. Barrett makes considering the research drastically contradicts his opinion.

Vertibral artery dissection leading to a stroke has a temporal relationship with cervical manipulations. The three biggest studies on this subject have shown virtually no causal association with vertibral artery dissection leading to stroke, which is the only type of stroke that can possibly have any association with neck manipulations.

In fact, according to the articles below. The chance of this type of stroke happen while just sitting in the waiting room of the family doctor is exactly the same as having a cervical neck manipulation as performed by a DC/DO/DPT.

The reason it's been associated with cervical manipulations is because this type of stroke almost always shows up as headache with neck pain. If the artery is early in the process of dissecting. It is nearly impossible even with advanced imaging to determine it between a benign head ache and a more serious condition. Only when the dissection starts to balloon and cause neurological impairment does the presentation from a common headache and neck pain change to a more insidious presentation.

The three largest studies on this subject "virtually" eliminate the chance of a healthy individual being injured in this manner.

Rather the natural history of type of injury follows clinically as. Patient comes in after painting the ceiling all weekend with a tight stiff neck with moderate headache, not relieved by NSAIDs. Patient is evaluated and determined to have a sprain/strain of the neck due to prolonged neck in extension. Patient is adjusted (chiropractic or DO) OR given muscle relaxer and prescription NSAID (MD) and sent home. Patient one to two days later had worsening and worsening symptoms, patient is taken to ER, patient undergoes CT/MRI/angiogram, patient is diagnosed with in process vertibral artery dissection. Patient that went to the chiro or DO was told Cspine manipulation was the cause by ER doc or neurologist. Patient that went to MD was told that the prolonged neck position in extension was the cause of injury to the vertibral artery by the ER doc or neurologist.

Cureus | Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation


"Our systematic review revealed that the quality of the published literature on the relationship between chiropractic manipulation and CAD is very low. A meta-analysis of available data shows a small association between chiropractic neck manipulation and CAD. We uncovered evidence for considerable risk of bias and confounding in the available studies. In particular, the known association of neck pain both with cervical artery dissection and with chiropractic manipulation may explain the relationship between manipulation and CAD. There is no convincing evidence to support a causal link, and unfounded belief in causation may have dire consequences."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2271108/

"There were 818 VBA strokes hospitalized in a population of more than 100 million person-years. In those aged <45 years, cases were about three times more likely to see a chiropractor or a PCP before their stroke than controls. Results were similar in the case control and case crossover analyses. There was no increased association between chiropractic visits and VBA stroke in those older than 45 years. Positive associations were found between PCP visits and VBA stroke in all age groups. Practitioner visits billed for headache and neck complaints were highly associated with subsequent VBA stroke."



http://stroke.ahajournals.org/conten...d-66f71a57d94c

"CD is an important cause of ischemic stroke in young and middle-aged patients. CD is most prevalent in the upper cervical spine and can involve the ICA or VA. Disability levels vary among CD patients with many having good outcomes, but serious neurologic injury can occur. Clinical reports suggest that mechanical forces play a role in a considerable number of CDs, and population controlled studies have found an association of unclear etiology between CMT and VAD stroke in young patients. Although the incidence of CD in CMT patients is probably low, and causality difficult to prove, practitioners should both strongly consider the possibility of CD and inform patients of the statistical association between CD and CMT, prior to performing manipulation of the cervical spine."

[MuscleScience]

Were a practitioner can be at fault if a person is in the processes of having a
Dissection artery or stroke is by missing the signs and symptoms that it's occurring. This is called a medical error of omission, in that say the doctor didn't fulling inform the patient of potential risks (informed consent) then said event happens. Regardless if the practitioner caused the event or not they are liable.

The second way is an error of commission where the practitioner failed to recognized a condition and either provided the wrong type of treatment maybe even one contraindicated, or provided no care at all.

In either case, when a person is going through a Vertibral artery dissection mid to late stages show a very stereotypical and very definitive pattern.

Signs and symptoms that would warn of a possible vertebral artery dissection with ischemia are often summarized as the 5 Ds And the 3 Ns (1):

Dizziness (vertigo, light-headedness)
Drop attacks
Diplopia (or other visual problems)
Dysarthria [Speech Disorder]
Dysphagia [Difficult or Painful Swallowing]

Ataxia of gait (Hemiparesis)

Nausea (possibly with vomiting)
Nystagmus
Numbness (hemianesthesia)

If a patient is experiencing some or most of these symptoms. The practitioner should know not do deliver any type of physical modality to the neck and should
Immediately do the proper standard of care.

[numbere]

I appreciate you playing devil's advocate MS.

By no means do I dismiss your claims.

Rather I was paraphrasing the diagnosis given to my brother in law by a Neurologist from UCFS.

[NACH3]

My brother in law, who's 43 and arguably in better shape than I, recently had a stroke while working out with a trainer.

His Neurologist linked the stroke to a recent neck manipulation by a Chiropractor which bruised his vertebral artery.

Chiropractic neck adjustments are the leading cause of stroke in people under 50.

Chiropractic's Dirty Secret:
Neck Manipulation and Strokes

There's a ton of information on this topic but Dr Barrett does a great job of summarizing everything in the link above.

This might be old news to some of you but I just wanted to share this with those who are not aware.

Very sorry to hear this, Brother! If in any way I can be of help lmk buddy! All the best to your Brother in law, your family and friends....

How's his recovery coming along?

[MuscleScience]

I appreciate you playing devil's advocate MS.

By no means do I dismiss your claims.

Rather I was paraphrasing the diagnosis given to my brother in law by a Neurologist from UCFS.

Hope I didn't come off as insensitive, I use cervical manipulations as part of my practice. I have it done to my self. I hope that he recovers fully.

By all means everyone should ask their chiro,PT or DO if having their neck manipulated is appropriate in all cases. I only use a cervical rotary neck manipulation (chiropractic adjustment or Osteopathic manipulation as it's commonly known) when I can get the joint to move when I need to with other neck manipulations. I don't prescribe to the theory it needs done on every visit if someone is asymptomatic.

[kelkel]

Numbere I hope your brother-in-law recovers well.

Interesting post and a very educational response by MS.

[numbere]

Very sorry to hear this, Brother! If in any way I can be of help lmk buddy! All the best to your Brother in law, your family and friends....

How's his recovery coming along?

Thanks NACH.

The event occurred a few months ago and he's doing well, there was no brain damage.

He was told to take a baby aspirin for a month then continue living a healthy active lifestyle.

I'm sure he could use a good HIT session from you but his current trainer is a lot easier on the eyes than you, too bad she plays for the other team.

Hope I didn't come off as insensitive, I use cervical manipulations as part of my practice. I have it done to my self. I hope that he recovers fully.

By all means everyone should ask their chiro,PT or DO if having their neck manipulated is appropriate in all cases. I only use a cervical rotary neck manipulation (chiropractic adjustment or Osteopathic manipulation as it's commonly known) when I can get the joint to move when I need to with other neck manipulations. I don't prescribe to the theory it needs done on every visit if someone is asymptomatic.

I sensed no sensitivity.

Suppose I should have been more through in the OP.

I only wanted people to be aware of the possible risks and to speak with their Chiropractor before having their neck manipulated.

He's a tally gut 6'4"ish and had been seeing this Chiropractor strictly for a prolonged neck ailment.

[numbere]

Numbere I hope your brother-in-law recovers well.

Interesting post and a very educational response by MS.

Thanks Kel.

He's fully recovered now.

I think he lucked out because he was in a session with a trainer that alerted the on staff EMT.

It must be scary to lose your eyesight for 20 minutes after some shoulder presses.

[kelkel]

It must be scary to lose your eyesight for 20 minutes after some shoulder presses.

Hell yes! I'd be stuck in my basement.

[numbere]

Hell yes! I'd be stuck in my basement.

The pain in the ass it would be telling Siri to dial 911 might give you another stroke lol.

[NACH3]

Forgot original quote

Thanks NACH

The event occurred a few months ago and he's doing well, there was no brain damage.

Very Glad to hear he had a full recovery!

He was told to take a baby aspirin for a month then continue living a healthy active lifestyle.

Sounds easy enough... I assume by the bottom he's working out strongly again

I'm sure he could use a good HIT session from you but his current trainer is a lot easier on the eyes than you, too bad she plays for the other team.

I'm sure she is haha - it would be badass if we all did get a session in tho
Better shape than you?! She must be a bad trainer

[NACH3]

The pain in the ass it would be telling Siri to dial 911 might give you another stroke lol.

Or relying on others to make a call instead of them playing on the damn thing in between sets too...

TBH id be scared to death if that happened man...

[songdog]

Hell yes! I'd be stuck in my basement.

Hell I had that happen in the squat rack in warm ups prior too a meet.I had too cut a lot of weight.

[MuscleScience]

What type of stroke was he diagnosed with? As in what location?

[numbere]

What type of stroke was he diagnosed with? As in what location?

I believe the diagnosis was a TIA.

They couldn't locate any arterial blockage in the brain.

[MuscleScience]

I believe the diagnosis was a TIA.

They couldn't locate any arterial blockage in the brain.

If indeed it was a TIA that he suffered. There is no possible way that a neck manipulation could have caused it. It's not physically possible, I would think a neurologist would know that?

[numbere]

If indeed it was a TIA that he suffered. There is no possible way that a neck manipulation could have caused it. It's not physically possible, I would think a neurologist would know that?

MS I'm not certain if it was a TIA.

We had this conversation over a week ago after a few glasses of wine.

[Proximal]

I have to say something here and it is not meant to be inflammatory.

Any traumatic movement to the neck can cause damage to any tissue in the neck - that includes the vertebral artery. This is more likely in an older individual (30's and beyond) who will very likely be having some hardening of the arteries simply due to aging. If you also account for additional damage due to plaque, you have an artery that is less flexible and more prone to damage with mandatory clotting/thrombus formation.

You now have the potential for that thrombus to break free, in which it is now called an embolism. This embolism can easily lodge in a smaller arteriole or capillary of the brain causing a TIA or CVA.

Could this trauma occur in a whiplash movement in a car accident or a roller coaster - sure. How about head-banging in which I believe there are documented cases causing such a problem? Again, very possible.

But, with a manipulation, you are locking a vertebral segment(s) in place, while rather abruptly moving the adjoining vertebra. This puts a VERY strong force through a SPECIFIC area of the vertebral artery. To claim that this could not result in vertebral artery damage potentially leading to a TIA or CVA appears to defy common sense.

Numbere, so happy he is recovered.

Scary, as I have aged, I often wonder what would happen if I suffered an "event" at the gym.

[MuscleScience]

I have to say something here and it is not meant to be inflammatory.

Any traumatic movement to the neck can cause damage to any tissue in the neck - that includes the vertebral artery. This is more likely in an older individual (30's and beyond) who will very likely be having some hardening of the arteries simply due to aging. If you also account for additional damage due to plaque, you have an artery that is less flexible and more prone to damage with mandatory clotting/thrombus formation.

You now have the potential for that thrombus to break free, in which it is now called an embolism. This embolism can easily lodge in a smaller arteriole or capillary of the brain causing a TIA or CVA.

Could this trauma occur in a whiplash movement in a car accident or a roller coaster - sure. How about head-banging in which I believe there are documented cases causing such a problem? Again, very possible.

But, with a manipulation, you are locking a vertebral segment(s) in place, while rather abruptly moving the adjoining vertebra. This puts a VERY strong force through a SPECIFIC area of the vertebral artery. To claim that this could not result in vertebral artery damage potentially leading to a TIA or CVA appears to defy common sense.

Numbere, so happy he is recovered.

Scary, as I have aged, I often wonder what would happen if I suffered an "event" at the gym.

I'll hit on one point, IF there is already arterial damage and a clot is formed, - cervical manipulation can dislodge it and cause some sort of ischemic event if it goes to the right tissue. However If know, this is a direct contraindication to manipulation and should not be done.

In and otherwise healthy individual unless someone is intentionally trying to harm someone there is very little evidence that a cervical manipulation as done by a well trained practitioner (DO/DC/DPT) and profound evidence to the contrary could cause anytype of damage to the artery.

The only cases I have seen where it was a factor were in people with undiagnosed connective tissue disorders, blood clotting disorders, or those on heavy blood thinners. Most of those case studies that looked at CVA's where manipulations done by none licensed practitioners, one was caused by a boyfriend on his girlfriend after watching the chiropractor do it once. Another was an native medicine man that performed a "chiropractic like," manipulation
To an elderly women.

If a person is PROPERLY evaluated by a PROPERLY TRAINED, practitioner there is a Extremely small risk, according to all the best evidence to date. I myself have probably delivered 20k or more cervical maniputions on my physio clinic. And never once had an adverse outcome. I have taught proper evaluation and manipulative techniques to almost every type of practitioner from Other DO's to DC' DPT' MD's and Physios. If done right, spinal manipulative therapy is one the if not the single most safe AND effective medical therapies there are for management of musculoskeletal conditions.

[Proximal]

I'll hit on one point, IF there is already arterial damage and a clot is formed, - cervical manipulation can dislodge it and cause some sort of ischemic event if it goes to the right tissue. However If know, this is a direct contraindication to manipulation and should not be done.

Agreed, but you really cannot evaluate the degree of hardening or plaque development, so that does produce an unknown variable.

In and otherwise healthy individual unless someone is intentionally trying to harm someone there is very little evidence that a cervical manipulation as done by a well trained practitioner (DO/DC/DPT) and profound evidence to the contrary could cause anytype of damage to the artery.

DPT came far after my license 30 years ago, but my friends and fellow P.T.'s manipulate as well so I'm on your side on this issue - I'm just saying the possibility is more than plausible.

The only cases I have seen where it was a factor were in people with undiagnosed connective tissue disorders, blood clotting disorders, or those on heavy blood thinners. Most of those case studies that looked at CVA's where manipulations done by none licensed practitioners, one was caused by a boyfriend on his girlfriend after watching the chiropractor do it once. Another was an native medicine man that performed a "chiropractic like," manipulation
To an elderly women.

If a person is PROPERLY evaluated by a PROPERLY TRAINED, practitioner there is a Extremely small risk, according to all the best evidence to date. I myself have probably delivered 20k or more cervical maniputions on my physio clinic. And never once had an adverse outcome. I have taught proper evaluation and manipulative techniques to almost every type of practitioner from Other DO's to DC' DPT' MD's and Physios. If done right, spinal manipulative therapy is one the if not the single most safe AND effective medical therapies there are for management of musculoskeletal conditions.

Always a sincere pleasure exchanging posts with you MS. You have my respect!

[MuscleScience]

Always a sincere pleasure exchanging posts with you MS. You have my respect!

We should snuggle :-)


Lol

[kelkel]

We should snuggle :-) Lol

Again......

[MuscleScience]

Again......

You're one to talk Mr Cuddles

[green22]

I've been looking to start Ciro treatments. My wife swears by them. I been using deep tissue massage and active release therapy with much success. Ready to start with Ciro but this has got me thinking???��