Neck chiropractic can be harmful to health; understand – 04/08/2023 – Equilibrium

Seeing a chiropractor has become a part of health care, so much so that 15% of adults in the United States do so each year. Critics say the field lacks scientific validity, but chiropractic treatments relieve pain for many people, and in the vast majority of cases are done without problems.

However, given the delicate nature of the spine, especially the upper neck vertebrae, the consequences of complications can be devastating. There is one injury in particular that causes serious concern: arterial dissection, in which blood vessels that carry blood from the heart to the brain are severed. In some cases, the patient may not notice the injury, and it may heal on its own. In others, rupture in the arterial wall can lead to the formation of a clot, resulting in a stroke (stroke) or even leading to death.

It is not clear how common this complication is after chiropractic care. One estimate points to one arterial dissection in every thousand neck manipulations, another to one in every 5.8 million (three of the four authors of this second study work for chiropractic associations).

Due to the severity of the injury, however, many spine specialists warn that chiropractic manipulation of the neck can be dangerous. Here’s what’s good to know if you’re considering seeking this treatment for your neck pain.

The risks of neck manipulation

Chiropractic manipulations involve high-velocity, low-amplitude movements with the spine. “We take the joint out into its limited range and give that joint a very quick push. That’s the high velocity aspect,” says William Lauretti, professor of integrated chiropractic therapies at the Northeast College of Health Sciences and spokesman for the American Association of Health Sciences. Chiropractic. “But we move it at a very small range – that’s the low amplitude.”

The concern for arterial ruptures is specific to neck manipulations. This is partly because the neck is more mobile and therefore more susceptible to injury. The torso is protected by the ribs, which is why the lower back does not rotate as much. The large arteries that supply blood from the heart to the brain run through the vertebrae in the neck, and this makes the blood vessels in this region more vulnerable.

“When you turn your neck from side to side, these vessels rotate within the bone,” says neurosurgeon Betsy Grunch of Gainesville, Georgia. “If you turn your head too quickly or turn around too quickly, as might happen in a car accident or manual manipulation, the vessel can twist suddenly.”

The most common symptoms of an arterial dissection are headaches, dizziness and vertigo. Weakness, numbness, or lateral paralysis may also occur.

In a widely reported case last year, a 28-year-old college student named Caitlin Jensen experienced dizziness and nausea after a chiropractor manipulated her neck. The professional called 911 and, at the hospital, doctors determined that Jensen had ruptured four blood vessels, leading to a stroke and cardiac arrest.

Today, nine months later, the student is starting to speak again, although she still cannot walk or swallow. Her right side of her body was paralyzed, as were her vocal cords. Her mother, Darlene Jensen, told the New York Times that her daughter is improving, but that the process is slow.

“It’s really exciting when you have good days and good therapy sessions,” says Jensen. “But there are other days when Caitlin struggles with things. It’s very frustrating and emotionally difficult. She just wants her normal life back.”

It’s virtually impossible to know how common cases like Caitlin Jensen’s are, because “there is no monitoring system in place to record these facts,” Edzard Ernst, emeritus professor of complementary medicine at the University of Exeter, wrote in an email.

“Many patients sue the chiropractor and settle with an out-of-court settlement. Many patients suffer a stroke and may not link it to the manipulation.” (Darlene Jensen says the chiropractor’s insurance company paid the claim that was claimed without objection.)

A study of more than 50,000 cervical manipulations found that about 16 out of every 1,000 resulted in fainting, vertigo and dizziness. Other researchers try to assess risk by working backwards: locating people who have had an arterial dissection and determining whether a significant proportion of them have had their necks previously manipulated by a chiropractor. For example, one small study found that 15% of arterial dissections occur after a sporting activity and 11% after chiropractic manipulation.

Several studies have shown that the risk of arterial dissection and stroke is three to 12 times greater in people who have had recent neck manipulation.

For Grunch, who treats one or two patients each year with the injury, the connection is clear. “Arterial dissection is a known complication of spinal manipulation.” So, although the risk is rare, she strongly advises against neck manipulation by a chiropractor.

Alan Hilibrand, director of spine surgery at the Rothman Orthopedic Institute in Philadelphia and past president of the Cervical Spine Research Society, points out that there is no unequivocal evidence in the scientific literature linking chiropractic care to arterial dissection. But he added that he was “very uncomfortable” with it and warned patients that manipulating the neck could be dangerous.

Are chiropractors criticized unfairly?

Many chiropractors reject the idea that their treatments can cause such serious damage. They point to reviews that found no link between neck manipulations and arterial ruptures, and research showing that people who see a GP are just as likely to have a stroke in the next few weeks as people who see a chiropractor.

Instead, they say, a visit to a chiropractor is more often a consequence of an arterial dissection rather than the cause.

“These patients had an artery injured in some way,” says Lauretti, causing neck pain and headaches. “Some go to the general practitioner, some go to a chiropractor. If the patient has a stroke after seeing the chiropractor, the chiropractor is to blame.”

Lauretti adds that when a patient comes to a chiropractor because they are experiencing neck pain, the practitioner needs to perform a thorough examination to rule out any danger signs before performing a neck manipulation.

Recognizing the fragility of the neck, some practitioners take a more conservative approach when treating this area. Philip Cordova of Houston points out that in his office he doesn’t turn patients’ necks too much to minimize the risk of injury. Some tell her “‘I don’t want you to touch my neck,’ and that’s fine,” says Cordova. “We work in another way.”

The risk of complications from chiropractic treatment of other parts of the spine is extremely low, and some research suggests that the practice is as beneficial as home exercise, physical therapy, and medication. As a result, many neurosurgeons and orthopedists — including Grunch and Hilibrand — sometimes refer patients to chiropractors for issues unrelated to the neck.

“I think it’s totally appropriate to incorporate chiropractic care as part of a conservative care plan,” Grunch points out.

Hilibrand agrees. “I don’t hesitate to refer patients to a professional I know,” he says. “Many of these professionals provide very good service.”

What to do to alleviate neck pain?

Accidents resulting from chiropractic manipulations are very uncommon, but because of their potential severity, it may be best to avoid the chiropractor if you are experiencing neck pain. Fortunately, there are other options.

The first line of treatment that Hilibrand recommends is over-the-counter pain relievers along with physical therapy. “Eighty percent of people with neck pain get better in the first six weeks, just these two interventions”, she says.

If the pain persists, it may be a case of opting for alternative therapies such as acupuncture or a massage technique known as myofascial release. You can go to the chiropractor for gentler manual therapy or traction, which involves stretching or less aggressive, more controlled movements (but according to Hilibrand, people with spinal compression should avoid chiropractic care). Steroid injections can also help reduce pain and inflammation.

In some situations, surgery may be needed as a last resort, but experts say non-invasive treatments often do the trick.

“Most patients with acute neck or back pain don’t need surgery,” says Grunch. “They just need a good, well-balanced conservative treatment plan.”

Translation by Clara Allain