Thursday, April 26, 2007

Is a Chiropractic Manipulation to the neck safe?

This month, in Self magazine, an article on the safety of a "Chiropractic Cervical Manipulation" was written. It was the most bias, one sided article I have read in a long time. It was so bad, my first response was "who is behind this". Its about a women who suffered a stroke after she had a manipulation to her neck. Though tragic, its rare. What is tragic, is to print this article. What is also tragic, now she is on a crusade to outlaw manipulations of the cervical spine.
My favorite line is "I don't believe in Chiropractic". Why, because I never knew I had become a religion. Doctors of Chiropractic are just that, they are Doctors. We use tools necessary to treat bio mechanical disorders. You want to describe us, call us bio mechanical neurophysiologist.
I have a friend who got polio from a vaccine, do we outlaw all Vaccines because of this incident. I have another patient who lost his father at the local Hospital. Their father went in for a routine procedure and was given meds, had a reaction to the drug and died. Does this mean that hospitals should be outlawed? How about the simple surgery that turns bad or the dental procedure that goes wrong, should these conditions be isolated or should they be taken to congress and banned.
The below is a response to the article from the American Chiropractic Association.

The American Chiropractic Association believes that patients have the right to know about the health risks associated with any type of treatment, including chiropractic; however, health care consumers should be aware that the risks associated with chiropractic treatment are infinitesimally small. In fact, research has shown negligible evidence to support a causal relationship between cervical spinal manipulation and vertebral artery dissection.

Medical standards dictate that a procedure with an adverse reaction less than 1 in 400,000 is considered “low risk.” According to scientific data, the odds of suffering a serious reaction from chiropractic cervical manipulation have been shown to be less than 1 in 3.8 million to 5.85 million manipulations. Studies have shown that the best estimates of the odds of suffering a serious complication from a chiropractic neck treatment are the same odds a person faces of dying in a commercial airline crash. Even so, the chiropractic profession has taken an active role in educating doctors of chiropractic to recognize possible risk factors for stroke in patients and encourages all doctors of chiropractic to immediately refer any high-risk patients to other specialists for further evaluation.
To properly assess the risks of chiropractic treatment, it must be compared against the risks of other treatments for similar conditions. Some of the most common treatments for musculoskeletal pain – including prescription and over-the-counter non steroidal anti-inflammatory drugs (NSAIDs) – carry risks significantly greater than those of chiropractic manipulation. For instance, a study from the New England Journal of Medicine estimated that at least 16,500 NSAID-related deaths occur among patients each year. Furthermore, according to a study from the American Journal of Gastroenterology, approximately one-third of all hospitalizations and deaths related to gastrointestinal bleeding can be attributed to the use of aspirin or NSAID painkillers like ibuprofen.
Contrary to what was reported in the story, the most common adverse reaction patients experience after spinal manipulation is minor discomfort, which – according to the scientific literature – usually fades within 24 hours. Studies have also shown that the injuries mentioned in your article – joint dislocations and bone fractures – more frequently occur after visits to health care professionals who are inexperienced or inadequately trained in spinal manipulation, rather than to licensed doctors of chiropractic. Studies have also shown that a patient can have a manipulation by another health care provider and when questioned, that manipulation is called "a Chiropractic Adjustment" even when it is not performed by a licensed Chiropractor.
Moreover, it should be mentioned that the referenced study from Neurology is fraught with design flaws too numerous to detail here. But most surprising is the fact that the study excluded eight patients who had suffered “iatrogenic” vertebral artery dissection - or artery tears caused by medical doctors. Meanwhile, the study found only seven patients that supposedly suffered the same reaction after cervical spinal manipulation.
It is also unfortunate that the magazine choose not to interview a patient who has benefited from chiropractic cervical manipulation. There are tens of thousands of success stories annually of patients whose lives were positively changed because of chiropractic care. Neither did it mention one of the many studies that points to chiropractic’s effectiveness for headaches and neck pain. For any health care intervention, the issue should be appropriateness, which involves balancing effectiveness and safety. Focusing only on risk and not potential benefit demonstrates an editorial bias, a lack of understanding of the issue, or a complete disregard for the available research. Several extensive reviews of the scientific literature from leading authorities have agreed that neck manipulation is safe, effective, and appropriate for patients with a number of very common complaints like neck pain and headache.

For example, a recent study was published in 2001, when researchers at Duke University found cervical manipulation appropriate for both tension-type headache and cervicogenic headache and noted that “cervical spinal manipulation has a very low risk of serious complications,” which may be “one of its appeals over drug treatment.” For patients with many types of neck pain and headache, there is at least as much scientific evidence showing that chiropractic manipulation is an effective treatment as there is for any other medical or surgical treatment.
In closing, I have to offer this, don't be ignorant. If your family Doctor or friends tell you "Don't let a Chiropractor touch your neck" reply back, "which form of adjustment do you not want me to have, you know there are numerous methods and ways to adjust the neck, the safest methods do not use rotation and some are pure decompressive. Most Doctors of Chiropractic don't use rotation in their moves which can compromise the vertebral arteries, I will be sure to make sure my Doctor of Chiropractic does not use Rotation". Just to let you know. We at CSI use NO rotation in ANY of our techniques, the techniques we use are not only safe, there is zero risk due to the anatomical way we work. Most MDs, DOs and PTs do not know all the different techniques out there, any more than we know all the surgical techniques that are used by them. To say, "don't go to a Chiropractor for a neck problem or a Low back problem" is as ignorant as saying "Don't go to an MD for a cold or an injury that requires surgery". A good Doctor, whether he is a DC or an MD knows his bounds through experience and training and when the patient does not fall with in his bounds he has a network of trusted health care providers he or she can refer to.
Fight back ignorance with knowledge, research and second opinions and don't always believe what you read.
Until next time, be well.


Pam Hambrick said...

It does happen, I am another one of those women, I also won a malpractice suit against a chiropractor for causing an artery dissection. It has basically ruined my life. If it has not happened to you, you cannot understand the consequences, I was in upper management, going 100 miles an hour, now I am lucky to go 1.

Marcia Benjamin said...

Thank you for your excelent elucidation, Dr. Weyman. I agree with you 100%. I went for a simple gallbladder surgery in 2001, and had mini-strokes in a deep part of my brain, as my blood pressure was improperly monitored throughout the procedure. I only learned what had happened to me after a highly skilled neurologist made the proper diagnosis a couple of months later, as he himself read my MRI - an MRI that was signed off as normal by another MD doctor. Meanwhile, I significantly struggled neurologically, and physically not knowing what had happened to me as MD doctors told me it was all up in my head. My right side of my body was affected, I had problems moving my arms, my legs, problems speaking... You and your decidated highly trained staff have not only provided me with the best care ever at CSI, assiting me cope with pain and disconfort, but helped me improve my life quality in general with only a few office visits. The neck adjustments that I have received by you without any rotation whatsoever, made me feel much better overall, and have improved my ability to concentrate and move better. Knowledge and professinal dedication have been the key words on my path of healing.

Dr.Terry Weyman said...

Pam, your right, it does happen and unfortunately, its rare. Just as some other procedures. If you do your exam right, you look for your red flags and you manipulate the neck the proper way with no rotation, it should never happen. I am so sorry you experienced this, my point is not to isolate the profession but the few that make the mistakes. Thank you for your comment