Chiropractic Cervical Manipulation: Putting Benefits & Risks Into Proper Perspective

Tuesday, February 16th, 2016
Woman With Headache

Hello, I’m Dr. Jeff Williams with Creek Stone Care right here in Amarillo, TX.

I have spent some serious time going through research abstracts, compiling lists, and battling to educate folks about chiropractic for several years now. What I wanted to talk about in this video today is the topic of cervical chiropractic adjustments which also means adjusting your neck. The one common thread some in the medical field seems to always come back to not this is an imaginary notion that cervical manipulation is dangerous. Not only that it is incredibly dangerous but they’ll say that it is being performed for very little pay-off in the form of pain relief or reduction of disability. Meaning, they claim it’s dangerous and there’s no benefit anyway so why do it?

Very quickly, and very succinctly….this is simply untrue.

Recently, there was a young, former Playboy model that passed away from a stroke. She was on the set at a photo shoot and had a bad fall. All of the reports agree on this fact. Several articles go on to say that the model went to the ER and was released. The model then went to her chiropractor some time after the visit to the ER. The visit didn’t seem to help so she visited a second time. After the second trip to her chiropractor, her pain and condition seemed to deteriorate. Ultimately she was put in the hospital after suffering a stroke. She was later removed from life support and passed away.

Even one of Chiropractic’s biggest detractors wrote an article on this specific incident admitting that it is unlikely that the chiropractor had anything to do with causing this issue because this was in the carotid artery. A complication of this sort is exceedingly rare in the vertebral artery but even far more rare or impossible in regards to the carotid artery. The incident was most likely cause by the fall, missed by the ER, and missed by the chiropractor, only to worsen and ultimately cause her death.

This sort of tragedy is just that….a tragedy. Preventing even one such event is the goal of all of us in the healthcare field regardless of discipline and my prayers go out to her family. When something terrible like this happens and the word “chiropractic” is anywhere in the mix, the detractors start emerging and spouting a lot of “told ya so’s” and other nonsense. For example, you’ll see and hear things like, “this happens all of the time, I’d never let a chiropractor touch my neck, it’s a pseudo-science, I’m a nurse and I’ve seen this a lot,” and on and on and on. Quite simply, according to research and evidence, these statements are false, biased, and baseless at minimum. At the most, they are libelous, slanderous, and hateful.

Chiropractic as a pseudo-science: I think most people are reasonable. They understand that chiropractic was discovered, or proposed, as a treatment by DD Palmer and the profession was furthered by BJ Palmer. Some in the medical end of healthcare will point to them and their assertions as a reason for people to turn away from present-day Chiropractic. I would say that, as with anything, Chiropractic has greatly expanded and advanced in understanding and in what it has to offer as well as in the research that backs the use of spinal manipulation, exercise, and mobilization. Think about it, when Chiropractic was first made into a healthcare treatment modality, medical doctors were still blood letting. Let’s just keep things in perspective. That’s all I’m suggesting. And let’s be clear, many chiropractors refer to, and accept referrals from, medical doctors daily. This isn’t a “doctor of chiropractic vs. medical doctor” discussion at all. The attempt here is not to compare two different professions that both deserve a great deal of respect. The goal is to educate about the benefits and risks of cervical manipulation and to keep things in proper perspective and context.

As for the rest of it, we chiropractors have a daily list of anecdotal evidence for how patients respond to what we do and we really don’t need validation. However, we have the validation through research. And not just a little bit of research. A lot of research. Many of Chiropractic’s detractors have built a life of comfort from their opposition to the profession. They own and operate big websites, write articles and books, and give lectures and seminars opposing Chiropractic. I can promise you, regardless of what they say, there will NEVER be enough research that comes out that will make them say, “You know, my whole life….I was wrong about chiropractic. They weren’t the fools….I was. Now I’m going to re-think everything hateful I’ve said about chiropractic for the last several decades.”

This just isn’t going to happen so, no matter the research quantity or quality that supports Chiropractic, they will continue the crusade by calling it rubbish and all kinds of other names so that they can continue with their lifestyles. But, that’s OK. As long as you know that most of this research is done by governments, insurance companies, Universities, and medical doctors. You know, people that either don’t necessarily have a dog in the hunt or people that downright don’t like chiropractors. So, I feel that you can trust the research. That’s what I’m trying to say.

There is a ton of it too so, to keep from completely boring you, I’ll just pick some out and give you the conclusions to these papers. I think by the time I’m done here, I’ll have made my points clearly.

Lets begin with the benefits of adjustments for the neck in particular.

A 2003 study published in the British Medical Journal concluded that manual therapy (spinal mobilization) is more effective and less costly for treating neck pain than physiotherapy, physical therapy, or care by a general practitioner.

This 2014 study by Dewitte et. al. published in Manual Therapy concluded “Pending on these patterns, specific mobilization and manipulation techniques are warranted. The proposed patterns are illustrated in 3 case studies. This clinical algorithm is the corollary of empirical expertise and is complemented by in-depth discussions and knowledge exchange with international colleagues. Consequently, it is intended that a carefully targeted approach contributes to an increase in specificity and safety in the use of cervical mobilizations and manipulation techniques as valuable adjuncts to other manual therapy modalities.”

A 2011 randomized clinical trial by Dunning et. al published Journal Of Orthopedic Sports Physical Therapy concluded “The combination of upper cervical and upper thoracic HVLA thrust manipulation is appreciably more effective in the short term than non-thrust mobilization in patients with mechanical neck pain.”

2011 by Yu et. al. concluded “Chiropractic management of atlantoaxial osteoarthritis yielded favorable outcomes for these 10 patients.”

2011 Puentedura et. al. published in the Journal of Orthopedic Sports Physical Therapists concluded “Patients with neck pain demonstrated a more favorable response when the (spinal mobilization) was directed to the cervical spine rather than the thoracic spine. Patients receiving cervical (spinal mobilization) also demonstrated fewer transient side-effects.”

2008 – Led by J. Guzman, The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders published their paper in SPINE journal . It was made up of an international, multi- disciplinary team of researchers that examined available research studies to determine the best treatments for neck pain. They found 17 studies that looked at various manual therapies. It found overall positive evidence for both mobilization and manipulation, particularly when combined with exercise. This led the authors to include mobilization, manipulation and other manual therapies among the “likely helpful” treatments for simple neck pain.

In comparison to anti-inflammatories, they concluded that there was “not enough evidence to make a determination” about the helpfulness of NSAIDs and other drugs.

Now for the benefits in headaches and migraines.

2016 – by Dunning et. al. and published in the BioMed Central Musculoskeletal Disorders journal concluded that Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with chronic headache, and the effects were maintained at 3 months.

1998 – Nelson, et. al and published in Journal of Manipulative and Physiological Therapeutics study concluded patients who received only chiropractic care showed significant improvement, on a par with those given the powerful prescription drug but without the side effects. The headache index, from a diary kept by each patient, showed chiropractic to have reduced the severity and frequency of headaches as well or better than the combined therapy or amitriptyline alone at each stage of the study.

2000 – A randomized clinical trial by Tuchin et. al. published in Journal of Manipulative and Physiological Therapeutics concluded that the results of this study support previous results showing that some people report significant improvement in migraines after chiropractic. Over 80% of participants reported stress as a major factor for their migraines. It appears probable that chiropractic care has an effect on the physical conditions related to stress and that in these people the effects of the migraine are reduced.

2001 – by Bronfort et. al. This paper concluded that chiropractic appears to have a better effect than massage for cervicogenic headache. It also appears that spinal manipulation has an effect comparable to commonly used first-line prophylactic prescription medications for tension-type headache and migraine headache.

2011 – Duke University published a paper in Spine Journal and said the study adds to the support of chiropractic in moderate doses as a viable option for the treatment of cervicogenic headaches.

So….clearly, the benefit has been established time and time again. If someone says there’s no benefit beyond that of simple mobilization, massage, or exercise, then they are simply ignorant of the information. Plain and simple.

Now, again, the gripe among some chiropractic detractors is that there is too much risk for no benefit. I have established the benefit. Let’s talk about the risk. Or lack thereof.

2015 – Kosloff et. al. published in Chiropractic and Manual therapies. They state the following: We found no significant association between exposure to chiropractic care and the risk of vertebral artery stroke. We conclude that manipulation is an unlikely cause of vertebral artery stroke. The positive association between primary doctor visits and vertebral artery stroke is most likely due to patient decisions to seek care for the symptoms (headache and neck pain) of arterial dissection.

2015 – Whedon et. al. studied the risk of chiropractic in older patients. Here’s what they found: Among Medicare B beneficiaries aged 66 to 99 years with neck pain, the incidence of vertebrobasilar stroke was too low to allow further analysis. Chiropractic cervical spine manipulation is unlikely to cause stroke in patients aged 66 to 99 years with neck pain.

2008 – This one was a big one – Cassidy et al did a comprehensive study with 9 years of compiled information. NINE years! vertebral artery stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.

I realize that some find research boring. I do not. Especially when I’m in a branch of healthcare that is commonly attacked by others that are ignorant of the research. I guess you can say it’s a necessary evil when we deal with things like this.

I hope I have adequately demonstrated through research that the benefits of cervical adjustments are most certainly there and that the risks are extremely low. Let’s be clear though. There are risks. There are risks with EVERYTHING you do including walking into the street. However, when we are objective and put things in proper context, it’s clear that the risk is minimal compared to the benefits.

Let’s do some comparing and contrasting here for the proper perspective. Let’s talk about something as innocuous as acetaminophen which is found in Tylenol. Tylenol is responsible for 56,000 emergency room visits per year, 2,600 hospitalizations, and 458 deaths…..PER YEAR. That’s just acetaminophen. Anti-inflammatories all together are estimated to be responsible for 16,500 deaths per year. So, again, let’s keep it all in proper perspective.

There are 70,000 chiropractors in the U.S. making it the third largest doctoral-level discipline in America yet Chiropractors have the lowest malpractice costs by a huge margin. The reason is because there is very little risk in going to a chiropractor. If things like this “happen all of the time,” chiropractic malpractice insurance would be sky-high yet, it’s the cheapest.

Looking at this graphic provided by the ACA, you can see that it’s estimated there are 5-10 complications following adjustments in approximately 10 million or about 1 in 1 million.

As I have said, there are risks with any treatment you can imagine including exercise, yoga, massage, or just taking a Tylenol. But when kept in proper perspective and context, it’s clear that chiropractic doesn’t carry a risk near almost every type of treatment in the traditional medical path.

To put the period at the end of the sentence….The Bone and Joint Decade Task Force review concluded that, in general, the physical treatments (including manipulation, mobilization, massage and exercise) have good evidence of effectiveness and are very rarely associated with any serious complications.

Let’s cover some real quick symptoms of stroke and arterial dissection in progress. The sudden onset of a severe headache that’s more intense than any headache you’ve ever had. A headache that’s accompanied by blurred vision, double vision, trouble swallowing or speaking, or severe dizziness. Headache with numbness, tingling, weakness or clumsiness in the arms or legs. Headache that is worse when you lay down. A headache in the temple area with pulsations in older folks. A headache accompanied by confusion, disorientation, or loss of consciousness. A headache with fever, vomiting, or severe stiff neck.

As you can tell, this situation has lots of different signs that cross over into other conditions and can be EXTREMELY difficult to recognize for anyone be it chiropractor or medical doctor. Even for the emergency room that reportedly saw the Playboy model prior to her seeing her chiropractor.

Now, if you’ve made it this far, you’re a real trooper. I have only one other topic I’d like to discuss. Why would there be a faction of the healthcare world that holds such disdain for Chiropractic that they would willfully ignore research and propagate lies about the profession?

Well, let me be honest and make an attempt at being completely objective: it’s partly because some chiropractors deserve it. If I were a medical doctor and I saw a chiropractor saying they can cure cancer, I’d have a problem with that. Now, understand that many times, those in medical world see and hear about the worst of the worst for different conditions. How many times does someone waltz in talking about how amazing their chiropractor is? It happens but, in general, patients go in to talk about what’s WRONG with them. Not about what feels good on account of their chiropractor. I would include that some chiropractors can be particularly aggressive and use rotational maneuvers while others are not aggressive and do not employ rotational maneuvers. For me personally, I prefer non-aggressive and non-rotational adjustments.

Now that I’ve said that, I’ll say this: MOST of the reason there are certain circles of chiropractic detractors in the medical world can be traced to the American Medical Association. In a case called Wilk vs. AMA, it was proven in Federal Court that the American Medical Association did the following or encouraged their members in the following manner:

  • Encourage ethical complaints against doctors of chiropractic;
  • Oppose chiropractic inroads in health insurance;
  • Oppose chiropractic inroads in workmen’s compensation;
  • Oppose chiropractic inroads into labor unions;
  • Oppose chiropractic inroads into hospitals; and
  • Contain chiropractic schools.
  • Conducting nationwide conferences on chiropractic;
  • Distributing publications critical of chiropractic;
  • Assisting others in preparation of anti-chiropractic literature;
  • Warning that professional association between medical physicians and chiropractors was unethical; and
  • Discouraging colleges, universities and faculty from cooperating with chiropractic schools.

This behavior started in the 1960’s and was passed down to all of the state medical associations then down to the individual practitioners in each state. This attack on Chiropractic did not officially end until the 1990’s although I’d argue it isn’t really over.

The AMA lost the case, by the way.

Considering this was proven in Federal Court, it isn’t hard to understand (or very surprising) that the anti-chiropractic chants that come about every single time a tragedy occurs no matter how rare it actually is will continue.

As long as people are educated to the actual facts, research, and stats, you should be able to keep the discussion and emotions that result from this sort of story in the proper context and perspective.

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Till next time……

The Amarillo Chiropractor Blog is written by Dr. Jeff Williams.
Amarillo TX Amarillo Pain & Accident Chiropractic Clinic provides customized chiropractic care to the Amarillo, Canyon, Pampa, Happy, White Deer, Dumas, Groom, Conway, Panhandle, Claude, Clarendon, Borger, Tulia, Hereford, Fritch, Bushland, and Vega communities. Visit our main website at www.amarillochiropractor.com for customized Chiropractic in Amarillo TX.
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by Jeff S. Williams, D.C.
Chiropractor Amarillo
Accident Chiropractic

http://www.creekstonecare.com