Chiropractic Neck Manipulation: Risk Of Hemiplegic Stroke?

Chiropractic neck manipulation is a common practice used worldwide to treat neck pain. However, there is a potential risk of cervical artery dissection, which can lead to stroke and even death. While the causal relationship between chiropractic manipulation and stroke is difficult to prove, several cases have been reported where patients have presented to the emergency room with stroke symptoms directly after receiving chiropractic neck adjustments. This has led to warnings from neurologists and the American Heart Association about the possible link between chiropractic neck manipulation and stroke. The precise incidence of artery dissection caused by chiropractic neck manipulation is hard to determine, but it is a rare occurrence, and the majority of chiropractic treatments are safe and effective. Nevertheless, patients should be informed of the potential risks and cautioned against aggressive neck manipulations, especially if they are already experiencing neck pain or other warning signs such as visual impairment, nausea, dizziness, or numbness.

Chiropractic neck adjustments can cause tears in the lining of blood vessels in the neck, known as cervical artery dissections, which can lead to stroke

Chiropractic neck adjustments can cause tears in the lining of blood vessels in the neck, known as cervical artery dissections, which can obstruct blood flow to the brain and lead to a stroke.

The neck is more mobile and susceptible to injury than the lower back, and the major arteries that supply blood from the heart to the brain are threaded through the neck vertebrae, making the blood vessels there more vulnerable. Cervical artery dissections are rare, affecting just one to three in 100,000 people per year, but they are one of the most common causes of stroke in people under 50.

The high-velocity thrust used in cervical manipulation can produce significant strain on carotid and vertebral vessels. This strain can cause tears in the inner lining of the vertebral artery, which is located toward the back of the neck. After a tear, blood can enter the arterial wall and form a blood clot. Pieces of the clot can then break off and cause a stroke, or the expanding artery wall can narrow the vessel and impede blood flow, leading to stroke.

The American Heart Association (AHA) has warned that the quick, thrusting neck movements used by chiropractors and other healthcare professionals to treat neck pain may be linked to cervical dissections in younger people. However, it is unclear whether the neck therapy is the cause, or if the pain from a tear prompts people to seek out such treatment.

The precise incidence of artery dissection caused by chiropractic neck manipulation is hard to prove, as people with neck pain often visit chiropractors, and dissections can cause neck pain. An individual may have already had a vertebral dissection before starting chiropractic treatment, making it difficult to establish a causal relationship.

While most neck adjustments are not dangerous, some spine specialists and medical doctors warn that chiropractic manipulation of the neck can be risky. They advise that the potential risk of stroke is serious enough to outweigh the potential benefits of the treatment.

The high-velocity thrust used in cervical manipulation can place significant strain on the carotid and vertebral arteries, increasing the risk of thrombus formation, ischemic stroke, paralysis, and death

Chiropractic cervical manipulation is a common practice used around the world. However, it is a potentially dangerous procedure, especially for those at increased risk for dissections. The high-velocity thrust used in cervical manipulation can place significant strain on the carotid and vertebral arteries, increasing the risk of thrombus formation, ischemic stroke, paralysis, and death.

The cervical spine is manipulated using a short, quick thrust over a restricted joint. This high-velocity neck manipulation is a chiropractic manual adjustment meant to restore the normal range of motion in the joint. However, this manipulation can result in a vertebral artery dissection, which can lead to a stroke. A vertebral artery dissection is a tear in the inner lining of the vertebral artery, which is located at the back of the neck and supplies blood to the brain.

Once a dissection occurs, blood can enter the arterial wall and form a blood clot. Pieces of this blood clot can break off and cause a stroke, or the expanding artery wall can narrow the vessel and impede blood flow, leading to a stroke. The risk of thrombus formation, ischemic stroke, paralysis, and even death is drastically increased.

Although rare, with one in 48 chiropractors experiencing such an event, it is crucial to highlight the risk associated with cervical manipulation. Receiving medical clearance before cervical manipulation in potentially at-risk patients could significantly reduce morbidity and mortality.

Furthermore, chiropractors are generally inexperienced in detecting the signs and symptoms of a dissection. Therefore, it is essential to encourage open dialogue and collaboration between chiropractors and physicians to ensure patient safety.

Vertebral artery dissection can obstruct blood flow to the brain, causing vision changes, difficulty walking, and weakness on one side of the body

Vertebral artery dissection (VAD) is a tear in the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. This tear can cause blood to enter the arterial wall and form a blood clot, which can then break off and cause a stroke. The clot can also cause the artery to narrow, reducing blood flow to the brain and leading to stroke. This obstruction of blood flow can cause a range of symptoms, including changes in vision, difficulty walking, and weakness on one side of the body.

VAD can occur spontaneously, but it is often associated with physical trauma to the neck, such as a blunt injury or sudden neck movements. Certain activities can increase the risk of VAD, including chiropractic adjustment, deep tissue neck massage, and yoga that involves hyperextension of the neck. The high-velocity thrust used in chiropractic cervical manipulation can place significant strain on the vertebral artery, leading to a tear and potentially causing a stroke.

The symptoms of VAD include head and neck pain, as well as stroke-like symptoms such as difficulty speaking, impaired coordination, and visual loss. It is important to seek medical attention immediately if any of these symptoms are present, as prompt treatment can improve outcomes. Diagnosis is typically made using a contrast-enhanced CT or MRI scan, which can identify the dissection and determine its severity.

The treatment for VAD aims to prevent stroke and typically involves the use of blood-thinning medications such as aspirin or heparin. In some cases, more invasive procedures, such as angioplasty or stenting, may be required to treat the dissection and restore blood flow. While most people with VAD make a full recovery, it is important to monitor for future dissections and continue taking blood thinners as recommended by a healthcare provider.

While chiropractors claim that neck adjustments are safe and effective for treating neck pain, medical doctors argue that studies show no long-term benefits and that the risk of stroke outweighs any potential benefits

Chiropractic neck adjustments, or cervical manipulations, are a common practice worldwide, with an estimated 35 million Americans visiting chiropractors every year. While chiropractors claim that neck adjustments are a safe and effective treatment for neck pain, medical doctors argue that studies show no long-term benefits and that the risk of stroke outweighs any potential benefits.

Chiropractic neck adjustments involve a short, quick thrust over a restricted joint to restore the normal range of motion in the joint. This high-velocity movement can result in a vertebral artery dissection, which is a tear in the inner lining of the vertebral artery, one of the four major arteries supplying blood to the brain. This tear can lead to the formation of blood clots, which can break off and cause a stroke, or the expanding artery wall can narrow the vessel and impede blood flow, also leading to a stroke. While this is an rare complication, it has been observed in several cases, with chiropractors urging open dialogue between chiropractors and physicians to reduce the risk of morbidity and mortality associated with cervical manipulations.

Medical doctors argue that there is no strong evidence supporting the use of cervical manipulations and that the potential risk of stroke outweighs any potential benefits. They recommend that patients with neck pain explore other treatment options, such as corticosteroid injections, ice and heat therapy, pain medication, specific exercises or stretches, topical treatments, or transcutaneous electrical nerve stimulation (TENS).

Furthermore, the American Heart Association (AHA) has issued a warning about the possible link between cervical manipulations and cervical dissections in younger individuals. They advise that individuals at risk of cardiovascular disease should exercise caution when considering cervical manipulative therapy.

While chiropractors maintain that neck adjustments are safe and effective for treating neck pain, medical doctors emphasize the potential risks associated with this procedure and recommend exploring alternative treatment options.

The American Heart Association recommends that patients be informed of the potential association between cervical neck dissection and cervical manipulative therapy before undergoing chiropractic neck adjustments

Chiropractic cervical manipulation is a common practice used worldwide. However, the high-velocity thrust used in cervical manipulation can strain the carotid and vertebral vessels, increasing the risk of thrombus formation, ischemic stroke, paralysis, and even death. The American Heart Association (AHA) recommends that patients be informed of the potential association between cervical neck dissection and cervical manipulative therapy before undergoing chiropractic neck adjustments. This recommendation is based on evidence suggesting a link between neck manipulation and stroke in patients aged 45 and younger, with cervical artery dissection being a leading cause of stroke in this age group.

The AHA statement, published in the October 2014 issue of Stroke, highlights that the quick, thrusting neck movements employed by chiropractors and other healthcare professionals during cervical manipulative therapy may cause cervical artery dissection. Cervical artery dissection is a tear in the lining of the cervical arteries, which carry blood to the brain. While this condition is rare, occurring in just 1 to 3 per 100,000 people annually, it is a significant cause of stroke in individuals under 50 years old.

The AHA advises chiropractors and osteopathic physicians to warn patients of the potential association between cervical manipulative therapy and cervical artery dissection. This recommendation is supported by several reported cases of complications following spinal manipulation, including a 32-year-old woman who suffered a vertebral artery dissection and subsequent brainstem infarction immediately after chiropractic manipulation. This patient's rapid deterioration and subsequent death underscore the critical importance of open dialogue between chiropractors and physicians to ensure patient safety.

Furthermore, receiving medical clearance before cervical manipulation can drastically reduce morbidity and mortality in patients who may be at increased risk for dissections. While the evidence regarding the direct causation between neck manipulation and stroke is inconclusive, the potential risk is serious enough to warrant caution. Therefore, patients considering chiropractic cervical manipulation should be informed of this potential risk and advised to seek immediate medical attention if they experience any symptoms indicative of stroke.

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