Chiropractic's Safety: Let's Look At The Facts

The other week while visiting with a patient during one of her appointments, she presented me with an article that her husband found in a past edition of the Reader’s Digest.  It was a short snippet from an internist (MD) in Michigan stating that he advised his patients that if they wanted to see a chiropractor that was fine “but don’t let them touch your neck”.  He states that this was because he has had a “number of patients over the years that have had strokes after chiropractic neck manipulations.”

I really found this amazing that he himself has seen “a number” of such patients.  Can significant complications occur? It seems that they can, according to case reviews.  Are they that common that one medical practitioner should see “a number of them”?  Statistically, no! 

Chiropractic adjustments (manipulation), even of the neck, is an extremely safe procedure when performed by a highly trained practitioner such as a doctor of chiropractic.  If it were not, malpractice liability premiums for doctors of chiropractic would not be among the lowest of all diagnostic level health providers.  This margin of safety is maintained due to the history of past health and of the current complaint which is done with each patient.  This is then followed up with screening tests for possible complications and possibly confirmatory x-ray or other special studies.  If the doctor of chiropractic practices “due diligence”, chiropractic care is extremely safe.  It can be much safer in fact than the use of  many over the counter remedies and pain relievers. 

A research paper published in 2001 in the Canadian Medical Association Journal found 23 reported strokes over a 10 year period.  This is only a one in 5.85-million risk that a chiropractic neck adjustment will be associated with a subsequent stroke.  Other studies have placed the risk at 1 in 500,000 to 1 in one million visits resulting in a serious event requiring medical attention.  In contrast, a statistical review in the March 2000 issue of the journal Pain, authors calculated that 1 in 1,200 patients taking NSAIDs (Aspirin, Ibuprophen, Celebrex, Motrin, Toradol, Relefen, Aleve, Lodene and others) for at least 2 months will die from stomach and intestinal complications.   I often ask those inquiring about this subject if they know anyone, personally, who has been hospitalized after receiving a “routine” medical procedure or taking a prescribed medication.  The answer is almost 100% of the time YES.  In contrast I will ask them if they, personally, know someone that has been hospitalized due to a chiropractic adjustment.  The answer to that is almost 100% of the time NO.

In the February 2008 journal, Spine, researchers noted that patients are no more likely to suffer a stroke following chiropractic treatment than they would after visiting their family doctor’s office.  The authors also noted that neck manipulation “is unlikely to be a major cause” of these rare stroke events.  It is doubtful whether a neck manipulation, as it is practiced by chiropractors, would have the force to damage healthy arteries. This seems to be supported by the significant number of patients who are treated without incident. 

This issue tends to creep into the media from time to time.  While it is an unfortunate complication that can happen, a handful of case and retrospective studies indicate that it is extremely rare and no more common that might be expected to happen with everyday life activities.  Routine daily activities that can create the situation which is proposed to cause strokes, such as sudden neck rotation and extension, these include over the shoulder checking while driving, sports, lifting, working overhead, falls, getting your hair washed at a salon, sneezing, and coughing.

To put the above mentioned risks into perspective let’s use the mid range number of 1 in 1,000,000 (that’s one million) figure.  We should consider that a review of risks which appeared in the September 1980 edition of JAMA found these “voluntary risks” in everyday activities:

Activity                                                   Risk of Death per Person per Year

Smoking: 20 cigarettes/day                               1 in 200

Drinking: 1 bottle of wine per day                       1 in 13,300

Football (Soccer)                                                1 in 25,500

Automobile driving (UK)                                      1 in 5,900

Motorcycling                                                        1 in 50  

Rock climbing                                                     1 in 7,150

Taking contraceptive pills                                    1 in 5,000

Power boating                                                     1 in 5,900

Skiing                                                                   1 in 430,000

Pregnancy (United Kingdom)                              1 in 4,350

 

Looking at the numbers above for many day to day activities performed without significant fear for one’s safety, we see that
chiropractic adjustment of the neck is considerably safer.  Considering the numerous benefits attributed to a balanced, properly functioning spine and nervous system, the minute risks posed to a properly evaluated and qualified patient in the chiropractic office should be considered more than acceptable.

Oh, returning to our Michigan, internist friend!  Extrapolating from the above study finding 23 cases in ten years, adjusting for a complication rate of 1 in 1,000,000, we could expect to see about 133 strokes per ten years.  This means that there would be about 13 cases of stroke per year, nation wide.  This internist evidently is either an ambulance chaser for such cases, practices in an area with some very sloppy chiropractors creating this “number of cases” in his area or he is simply exaggerating the truth.  But those are topics for other articles!

For your empowerment,

       Dr. Heller