Chiropractic may cause strokes

[edthedoc]

Interesting new study shows possible link between chiropractic treatment and tearing of neck arteries causing stroke. Of course dismissed by chiropractics but interesting comment by researchers along the lines of "there's no evidence that chiropractic neck treatment works so it's not worth the risk of causing strokes even though this risk is low".



"The latest research, published in the journal Neurology, looked at dozens of cases of "cervical arterial dissection" - a tearing of an artery near the spine - followed by a stroke arriving at the University of California at San Francisco Medical Center and Stanford Medical Center over a five year period.

They found that these patients were six times more likely to have had spinal manipulation in the 30 days prior to their stroke than people who had had a different kind of strokes.

Dr Wade Smith, who led the study, said: "These observations suggest that spinal manipulative therapy can directly produce dissection. "



How about some more intelligent discussion about this.

P.S.
Please, mature responses only.

[BillyJoe]

Hey, Eddy, how's your pussy doing?

[BillyTK]

Originally posted by edthedoc
Interesting new study shows possible link between chiropractic treatment and tearing of neck arteries causing stroke. Of course dismissed by chiropractics but interesting comment by researchers along the lines of "there's no evidence that chiropractic neck treatment works so it's not worth the risk of causing strokes even though this risk is low".



"The latest research, published in the journal Neurology, looked at dozens of cases of "cervical arterial dissection" - a tearing of an artery near the spine - followed by a stroke arriving at the University of California at San Francisco Medical Center and Stanford Medical Center over a five year period.

They found that these patients were six times more likely to have had spinal manipulation in the 30 days prior to their stroke than people who had had a different kind of strokes.

Dr Wade Smith, who led the study, said: "These observations suggest that spinal manipulative therapy can directly produce dissection. "



How about some more intelligent discussion about this.

P.S.
Please, mature responses only.

Hmmm--the summary's a bit vague for me to pass any kind of judgement; do you have links to the actual study please?

[RichardR]

SF Chronicle article: http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2003/05/13/MN94608.DTL

It’s not a new idea, though:

http://www.quackwatch.org/01QuackeryRelatedTopics/chirostroke.html

http://www.chirobase.org/15News/neurol.html

[Zombified]

Interesting. I'd heard about stroke risk before but the chiropractic industry always seemed to pass those off as isolated incidents or anecdotes. I think this is the first report I'd heard of an established statistical correlation.

Interesting also is the chiropracters' reaction; they don't seem to understand what the study actually says, if the article reports it correctly. The study presumably establishes a statistical correlation, it does not examine how chiropractic adjustments might lead to a stroke. How much force the chiropracter believes he's exerting is irrelevant, the correlation exists.

[edthedoc]

Sorry about the lack of link: http://news.bbc.co.uk/1/hi/health/3020923.stm

BillyJoe: I politely asked for sensible mature posts only. Please do not post to this thread unless you have something intelligent, and relevant to add to the thread. I'm going to raise this with the moderators because it is becoming increasingly difficult to hold a decent discussion on this forum because of people like you.

[spoonhandler]

From the article: However, Professor Alan Breen, a member of the General Chiropractic Council, was critical of the study.

He said: "It is irresponsible to suggest that chiropractic has caused these effects based on a study of this small size.

"What you have to remember is that someone who is in the process of having a dissection often experiences neck pain - precisely the symptom that might influence them to seek help from a chiropractor.

"Many of the people in this study who have gone on to suffer a stroke may have been experiencing an arterial dissection before they decided to consult a chiropractor."
My question: if it is likely that someone attending a chiropractic clinic with neck pain is in the process of 'experiencing' an arterial dissection, what do chiropractors do to exclude this as a possible cause of the symptoms described by the patient before attempting to treat them with manipulation only? Are patients advised their symptoms may be an indication of an imminent stroke?

Also, what are the likely causes of arterial dissection if chiropractic treatment is excluded?

[Julia]

The article states that they "aren't talking about a large number of victims", but if you happen to be one of them, that is hardly comfort.

I have had an aversion to chirpractors for a few years now. I
started to have spinal problems - both cervical and lumbar - about six years ago. Pain causes desperation. I succumbed to trying things I would not usually consider. Chiropractic treatment and even accupuncter were two acts of that desperation.

They both resulted in my being hospitalized. After one chiropractic treatment, my left leg and foot became temporarily paralyzed. I was actually told by the chiropractor that it was just common for a patient to get worse before they get better.

I don't know what, if any, controls the UK puts on this health field. I am dissapointed at how lax they seem to be in the US. I am glad to see at least this study casting some negative slant on what I view as a bunch of quacks.

[Zombified]

Originally posted by Julia
The article states that they "aren't talking about a large number of victims", but if you happen to be one of them, that is hardly comfort.And spoonhandler quoted this quote:
It is irresponsible to suggest that chiropractic has caused these effects based on a study of this small size.
The methods by which you decide whether you have a statistically significant effect are well understood. I would expect the actual study includes this. You don't necessarily need thousands of cases to decide that a procedure is hazardous, especially when it has no benefits, you just need a statistically significant result.

Unfortunately, Neurology wants $20 for a PDF of the actual paper on their website (http://www.neurology.org), and its not worth that much to me (and I probably wouldn't understand much anyway). However, the Highlights section has this to say:
Neck manipulation is causal in vertebral dissection

Smith et al., using a nested case-control design, compared patients with and without cervical arterial dissection and found that recent spinal manipulative therapy was an independent risk factor for stroke or TIA from vertebral dissection.

The accompanying editorial by Williams and Biller considers this possible risk of chiropractic. They note that Smith et al. addressed the "chicken–egg" issue of chiropractic manipulation for neck pain: Could the symptoms of dissection have prompted the visit to the chiropractor? The study carefully pursued this possibility with interviews of all subjects. Whereas recall bias as well as age differences in the control vs dissection patients are concerns, the sixfold increase of dissection/stroke suggests that the risk of chiropractic neck manipulation for patients with acute neck pain outweighs its benefits.The reference to experimental design and consideration of independance suggests that the authors knew what they were doing statistically, and it sounds like the researchers were careful to consider the possibility that at-risk patients sought chiropractic care at a higher rate.

[BillyJoe]

Originally posted by edthedoc
BillyJoe: I politely asked for sensible mature posts only. Eddy, my dear friend, you can start as many threads as you like but you cannot control the input from other posters. That was the point of my reply.
(Also, I have a pussy just like yours so I feel a sort of affinity :) :D )

Originally posted by edthedoc
Please do not post to this thread unless you have something intelligent, and relevant to add to the thread. Please, kindly, do not tell me what to do.
You do not actually own this thread, Eddy.

Originally posted by edthedoc
I'm going to raise this with the moderators.....I would suggest my dear friend, Hal Bidlack. He is on record as owning up to being a "stuff shirt".
The two of you should get on famously :D
But seriously, they will not help you in this matter because, apart from Hal, they all have a sense of humour

Originally posted by edthedoc
.....because it is becoming increasingly difficult to hold a decent discussion on this forum because of people like you. You have slandered me.
But, don't worry, I won't go running off to the moderators.
(However, I do know a certain Maxwell ;) )

[BillyTK]

Originally posted by Julia
I don't know what, if any, controls the UK puts on this health field.

In the UK, chiropractors have to be registered with the General Chiropractic Council (http://www.gcc-uk.org/), are regulated by the Chiropractors Act 1994 (http://www.hmso.gov.uk/acts/acts1994/Ukpga_19940017_en_1.htm#tcon) and must have an accredited qualification (typically degree level) in the subject.

According to the abstract (http://www.neurology.org/cgi/content/short/60/9/1424) Zombified kindly provided a link for Smith et al used a sample size of 457--151 participants who had suffered a stroke, 306 participants used as controls--with the 151 participants subsequently assigned to two conditions--51 patients who had suffered "cervical arterial dissection" and 100 who had suffered some other form of stroke. My immediate response would be that matching different sample sizes like this can be problematic, although there's statistical tests which can account for this (damn, where's my Robson's?). My other response would be that there may be problems generalising from from such a small sample size; in the BBC article Smith notes that the incidence of stroke is 10 per 100,000 anyway (<>24,000 for the US?), but regardless of the problems of small sample size, there's a correlation which needs to be taken into account, and further research wtih larger trials undertaken. I remember a report from a few years back suggesting that hairdressing chairs could be linked with stroke because of the way they inclined the neck, but I digress.

My gut feeling is that there's always some degree of risk with any treatment, and ultimately you've got to weigh up the negative and positive outcomes. Of course it's always the problem of attempting to become fully informed on any treatment--I've always wondered if there's an inverse relationship between amount of empirical data and degree of quackery involved in any practice. So if I lived in the US and was at risk of stroke I'd be careful about seeking chiropractic treatment for neck compaints, or for having any treatment which involved wrenching of the neck. But then, if it's the case that US chiropractors are unregulated, I'd be wary about going anywhere near them anyway.

[Kally]

Spinal Roulette?

In 1992, researchers at the Stanford Stroke Center asked 486 California members of the American Academy of Neurology how many patients they had seen during the previous two years who had suffered a stroke within 24 hours of neck manipulation by a chiropractor. The survey was sponsored by the American Heart Association. One hundred seventy-seven neurologists reported treating 55 such patients, all of whom were between the ages of 21 and 60. One patient had died, and 48 were left with permanent neurologic deficits such as slurred speech, inability to arrange words properly, and vertigo. The usual cause of the strokes was thought to be tearing of the vertebral artery walls [3]. A recent review of 116 articles published between 1925 and 1997 found 177 cases of neck injury associated with neck manipulation, at least 60% of which was done by chiropractors [4].


One patient proven to have been killed by neck manipulation was Kristi A. Bedenbaugh, a medical office administrator and former beauty queen from Little Mountain, South Carolina. In 1993, Kristi consulted a chiropractor seeking relief from the pain of sinus headaches. During her second visit, she suffered a stroke immediately after the chiropractor manipulated her neck. She died three days later, one day before her 25th birthday. The autopsy revealed that the manipulation had split the inside walls of both of her vertebral arteries, causing the walls to balloon and block the blood supply to the lower part of her brain. Additional studies concluded that blood clots had formed on the days the manipulation took place. In 1997, the State Board of Chiropractic Examiners of South Carolina issued a consent order in which the chiropractor agreed to pay a $1,000 fine and to acquire 12 hours of continuing education credits in the areas of neurological disorders and emergency response.

http://www.quackwatch.org/01QuackeryRelatedTopics/chiro.html

Dear Kally,

Observational studies.

How does the stroke rate compare to the non-chiropractic stroke rate?


A recent review of 116 articles published between 1925 and 1997 found 177 cases of neck injury associated with neck manipulation, at least 60% of which was done by chiropractors


So that is 177 cases (only of neck injury, not stroke) over 72 years, so about 2.5 cases of neck injury per year. I think we have an epedemic on our hands. :rolleyes:

I'm not saying that incompetent chiropractors are beyond this, but making it sound like a major thing is absurd. There is a much higher rate of non-chiropractic stroke. Talk about that some.

Sincerely,

S. H.

[Kally]

I'm not interested in playing Spinal Roulette no matter what any study says.

Kally

Dear Kally,

I'd agree with that, but note that you are probably more at risk from strokes from non-chiropractic means.

Sincerely,

S. H.

[Kally]

Who said chiros caused the most strokes? For gawd's sake I'm an RN and I've seen it all. Very rarely we get one caused by a chiro... Of course they are more rare than other types of cerebral vascular accidents. It actually angers the physical therapists the most. Of course this is only anecdotal evidence and we know what that's worth. lol

[BillyTK]

Originally posted by Kally
Spinal Roulette?
One patient proven to have been killed by neck manipulation was Kristi A. Bedenbaugh, a medical office administrator and former beauty queen from Little Mountain, South Carolina. In 1993, Kristi consulted a chiropractor seeking relief from the pain of sinus headaches.

Good grief! Chiropractors in the US think they can treat sinus problems? What claims are these guys making?

[Denise]

Let's not forget that some are treating infants for ear infections. As we all know, untreated ear infections can lead to irreversable hearing problems.

[Quasi]

The reason people are upset about this is because chiro do not test their practice. For example, no medical school professor, nor any chiro has ever shown a "subluxation" exists. Think about that. Further, if a standard practice were to cause 1 in 100,000 strokes even with efficacy, it would be stopped, or modified. Further, the Massachusetts chiro licensing board does not investigate or prosecute people claiming to be licensed, nor does the attourney general, so just say you are licensed and you are. So even though it is "regulated," it really isn't. What regulation does is it stops the public from suing quacks and protecting snake oil salesmen. You literally have to prove the chiro ripped you off and hurt you using practices outside of the licensure (good luck!) The same is true for naturopathy and the 1994 DSHEA and 1994 FDC acts, which make it legal to commit health fraud on a large scale. Think about it, if you licensed armed robbers, you would have to prove they robbed you outside of the licensure to prosecute them, or get your money back. This is why alt/comp people want licensure, to cover up their incompetence.

Quasi

[Dr. Popalot]

I said it once and I'll say it again. Spinal manipulation has been shown to be effective for neck and low back pain. It has not been proven to be effective for visceral ailments. Many DC mistakenly believe they are somewhat effective for these diseases. If you need a rational DC I suggest you check with the National Association of Chiropractic Medicine.

[Soapy Sam]

I just commented to AP re Chiropractic on another thread here. I do get the feeling (based mostly on what I read on this forum) that CP in the U.S. is a lot less regulated/ responsible/ mainstream than in the U.K. (Other opinions welcomed).

My one experience of CP (in the UK) is very positive. No nonsense, X-rays taken before treatment, a diagnosis that echoed what a physiotherapist had been telling me for years, simple manipulative treatment of a purely spinal problem and a massive (and seemingly permanent ) improvement in symptoms. The cost was less per hour than a garage mechanic would charge and appointments were made quickly and kept.

To expect spinal manipulation to help a sinus problem seems silly.

Neck manipulation can be quite violent, though nothing I experienced was worse than the sort of neck jolt I often get at work due to my so-called "safety " hard hat hitting an I-beam because it has obscured my upward and forward vision. I find it hard to believe that what was done to me could damage an artery. In an elderly person, this might be more likely.

There clearly is a risk involved with spinal (especially cervical) manipulation. It would seem silly to take a risk unless there is a reasonable likelihood of the treatment being beneficial. If you have a musculo skeletal problem, manipulation may help. If you have a sinus problem and go to a CP, you need to see a neurologist too, or a psychologist. You may be insane.

Dear Soapy Sam,


Neck manipulation can be quite violent, though nothing I experienced was worse than the sort of neck jolt I often get at work due to my so-called "safety " hard hat hitting an I-beam


I agree.

I'd also add that some skeptics, who obviously dislike chiropractic because of its historical roots (although, let's talk about conventional medicine's roots sometime...), claim the rate is soooo large, when in fact, one is much more likely to get a stroke from a non-chiropractic source. Some skeptics will try to relate those just to get rid of chiropractic.

You want strokes from a non-chiropractic source, let's look at some medicines.

Sincerely,

S. H.

[Nyarlathotep]

Originally posted by BillyTK


Good grief! Chiropractors in the US think they can treat sinus problems? What claims are these guys making?

I've got a better one. I once had a chiropractor honestly claim he could help my sons Down Syndrome.

I have no idea what he was thinking. Perhaps he was going to twist the spine until that lil' 27th chromosome popped off his genes.

[BillyJoe]

Originally posted by Denise
Let's not forget that some are treating infants for ear infections. As we all know, untreated ear infections can lead to irreversable hearing problems. Certainly a misuse of Chiropractic (see popalot's post for the proper indications for chiropractic treatment - we may disagree about the mechanism but studies have shown that Chiropractic has been useful for treating neck and back problems) but, interestingly, recent medical evidence indicates that antibiotic treatment of middle ear infections is rarely useful and that middle ear infections rarely cause irreversible hearing loss.

[BillyJoe]

Originally posted by Sherlock Holmes
I'd also add that some skeptics, who obviously dislike chiropractic because of its historical roots.... You should probably ask sceptics about that. I think you might find that this is only a small part of their problem with chiropractic

Originally posted by Sherlock Holmes
.....although, let's talk about conventional medicine's roots sometime. Well, lets talk about it. Certainly medicos don't mind, they talk about it with an ironic smile and perhaps a little nostalgia.....

Originally posted by Sherlock Holmes
.....[sceptics] claim the rate is soooo large, when in fact, one is much more likely to get a stroke from a non-chiropractic source. Yes, it's a rare event. However some claim (wrongly) that chiropractic is totally ineffective and therefore claim (correctly) that there should be zero tolerance for side-effects.

Originally posted by Sherlock Holmes
You want strokes from a non-chiropractic source, let's look at some medicines.Well you have to balance side effects against effectiveness. I think you may need some examples to bolster your claim.

[Zombified]

You need to understand the difference between relative risk and absolute risk. Many things cause strokes, some in large numbers. However, if you risk of stroke is relatively normal, you will increase it by six times (according to this study) if you have your neck manipulated. That is a considerable increase. That does not mean there are six times more strokes from manipulation than anything else, however.

Consider a million people, and just for the sake of example, assume they have a 1/1000 risk of a stroke, and that 5% get neck manipulations (fifty thousand). Their risk is 6 out of every thousand, or about 300 strokes. The remaining, unmanipulated get 950 strokes. The total number is greater because even though the individual risk is smaller, their numbers are a lot larger. Note that this is an oversimplified example with made-up numbers, but it should illustrate the difference.

I believe I've heard of studies that indicate that chiropractic is somewhat effective for the temporary relief of low back pain. I haven't heard anything about chiropractic being shown effective for neck pain (provide something if you know of it), nor that it is a suitable long term therapy. Also, it's not clear that its more effective than other methods, like massage or stretching, that are much less risky. So chiropractic is far from your only choice.

BillyJoe or Popalot, what would you think of a chiropracter who told his patients they needed weekly manipulations to correct supposed misalignments for which there were no symptoms at all, but which he claims will lead to back problems in later life? This isn't theoretical: I know at least one person seeing such a chiropracter.

[Dr. Popalot]

Zombefied,
I would tell you that there is no proof in any peer reviewed journal that there is such a thing as preventive care in the chiropractic field. Your friend is being misled. This doctor probably needs to be turned over to his board of examiners for disciplinary action.

Can MD's prevent future infections (years away) by giving anti-bioitcs today? How about preventive surgeries? If I pull on your shoulder will it prevent it from dislocating next month? If I drill into a healthy tooth will that prevent a future cavity?

If your friend likes the treatment then it about a useful as a massage, you get it because it feels good, but your not preventing anything.

[Dr. Popalot]

Zombefied,
I would tell you that there is no proof in any peer reviewed journal that there is such a thing as preventive care in the chiropractic field. Your friend is being misled. This doctor probably needs to be turned over to his board of examiners for disciplinary action.

Can MD's prevent future infections (years away) by giving anti-bioitcs today? How about preventive surgeries? If I pull on your shoulder will it prevent it from dislocating next month? If I drill into a healthy tooth will that prevent a future cavity?

If your friend likes the treatment then it about a useful as a massage, you get it because it feels good, but your not preventing anything.

[BillyJoe]

Dr. Popalot, I see you've posted my reply as well :D

Hmmm.....perhaps I let it stand (hoping I haven't been too uncritically swayed by your previous posts on this subject).

[Zombified]

I certainly agree with your opinion of "preventive" chiropractic adjustments, Pop.

[BillyTK]

Originally posted by Dr. Popalot
Zombefied,
I would tell you that there is no proof in any peer reviewed journal that there is such a thing as preventive care in the chiropractic field. Your friend is being misled. This doctor probably needs to be turned over to his board of examiners for disciplinary action.

Can MD's prevent future infections (years away) by giving anti-bioitcs today? How about preventive surgeries? If I pull on your shoulder will it prevent it from dislocating next month? If I drill into a healthy tooth will that prevent a future cavity?

If your friend likes the treatment then it about a useful as a massage, you get it because it feels good, but your not preventing anything.

In the interest of fair discloure ;) I'll admit to seeing a chiropractor (British variety, heavily regulated), typically a couple of appointments a year, and he's very clear that treatment is just that- treatment, not prevention. He can deal with the problems I'm experiencing but can do nothing to address their cause; that bit's down to me, by taking the right form of exercise, adjusting my posture and taking simple precautions such as making sure my chair and the computer on my desk are positioned correctly.

[BillyTK]

Originally posted by BillyTK


Good grief! Chiropractors in the US think they can treat sinus problems? What claims are these guys making?

I've since been corrected by my wife that where sinus problems are the result of muscle tension which stops the sinuses (sinii? is there a plural of sinus? is sinus the plural?) from working properly, then chiropractor could help by releasing the tension.

[BillyJoe]

BillyTK,

Originally posted by BillyTK
I've since been corrected by my wife that where sinus problems are the result of muscle tension which stops the sinuses from working properly, then chiropractor could help by releasing the tension. Chiropractors cannot treat sinus problems. Fullstop.
Also, as far as I know, sinuses are not affected and can not be affected by muscle tension. They are merely spaces within the skull bones lined with mucous membrane and have no connection with muscles.

Originally posted by BillyTK
sinuses (sinii? is there a plural of sinus? is sinus the plural?) "sinuses" is correct.

regards,
BillyJoe

[BillyTK]

BillyJoe,

Chiropractors cannot treat sinus problems. Fullstop.
Also, as far as I know, sinuses are not affected and can not be affected by muscle tension. They are merely spaces within the skull bones lined with mucous membrane and have no connection with muscles.

Seems like we're both right (and wrong):
Sinus Headaches and Sinus Pain Are Not Always What They Seem (http://www.ent-consult.com/sinus_disease_pro.html)
Patients come to me complaining of sinus headaches. They point to the area over the eyes (where the frontal sinuses are) or the area under the eyes (where the maxillary sinuses are located) and ask for sinus relief. Actually, the sinuses are rarely painful due to infection. Even when you are blowing handkerchiefs of yellow pus, there is rarely pain. But, when there is a painful muscle in the back of the neck, the pain is radiated to the sinus area. The treatment is to get the neck well . We do this by checking the posture at work and reading - office typist chairs are good, soft couch chairs are bad, and lighting can be important too. Light from the ceiling or shoulder is good, glare from in front is bad. Then I have the patient do neck stretching; gently turn to see who is behind you. And head leaning onto the shoulder. This is best done in the shower, with the shower stream hard and comfortably hot., for 3 minutes.

(Of course, my wife is completely correct on this matter and any inaccuracies are wholly the result of my misinterpretation :D )

"sinuses" is correct.

regards,
BillyJoe

Thanks!

[Zombified]

Originally posted by BillyTK
Seems like we're both right (and wrong)Those aren't sinus headaches, those are misdiagnosed muscle tension headaches. Migraines also sometimes get misdiagnosed as sinus headaches (they don't necessarily need to be severe), and those do not involve muscle tension, though muscle tension can be one of many triggers.

I am not aware of any actual evidence that chiropractic adjustment can do anything for muscle tension headaches, let alone any other kind. That some headaches involve neck muscles is not sufficient. There is zero chance it would do anything for a migraine.

Considering that most headaches can be treated with over-the-counter pain medication, taking the risk of unproven chiropractic manipulation seems rather foolish.

If your headaches are severe or frequent enough that you'd see someone about them, see a real doctor; you may need real treatment. A chiropracter does not have medical training and cannot diagnose what type of headache you might have.

[BillyTK]

Hi Zombified,
Those aren't sinus headaches, those are misdiagnosed muscle tension headaches. Migraines also sometimes get misdiagnosed as sinus headaches (they don't necessarily need to be severe), and those do not involve muscle tension, though muscle tension can be one of many triggers.

I am not aware of any actual evidence that chiropractic adjustment can do anything for muscle tension headaches, let alone any other kind. That some headaches involve neck muscles is not sufficient. There is zero chance it would do anything for a migraine.

Considering that most headaches can be treated with over-the-counter pain medication, taking the risk of unproven chiropractic manipulation seems rather foolish.
Maybe I should've been clearer on what I meant by "both right and wrong"! I'm wrong in suggesting "that where sinus problems are the result of muscle tension which stops the sinuses from working properly", but we agree that what presents as sinus headache can be muscular in origin. As a patient I'd be calling that a sinus headache.
If your headaches are severe or frequent enough that you'd see someone about them, see a real doctor; you may need real treatment. A chiropracter does not have medical training and cannot diagnose what type of headache you might have.
I'd certainly agree with your advice about seeing a doctor and that Chiropractors shouldn't be diagnosing headaches, but I'm not sure if it's the case that British chiropractors have no medical training; I suspect this is another of the many differences between typical US practice and British practice.