Manipulation of the neck and stroke: time for more rigorous evidence
I’m not sure how many people have managed to be exposed to this particular article as well as a recent one in Canada, but I thought I might address it anyway. These two articles suggest that the risk of stroke with cervical manipulation “occurs regularly.” I will address some issues, but be sure to read the editorial in this same journal ( eMJA: Manipulation of the neck and stroke: time for more rigorous evidence http://www.mja.com.au/public/issues/176_08_150402/bre10066_fm.html). First of all, by all standards there are no comparisons as to the safety of spinal manipulation (with possible exception of acupuncture). NSAIDs alone cause 16,000-19,000 deaths per year. Risk of vascular incidents with cervical manipulation is real, although the incidence has recently been cited to be as low as 1 in 5-6 million manipulations. And I firmly believe that the incidents that have been recorded in the medical literature (fewer than 100 in the recorded literature) are a matter of the DC being in the wrong place at the wrong time doing the wrong thing. The article firmly addresses other issues that show the poor methodology used in recent articles against cervical spinal manipulation. Incidentally, in my five years of practice I have given roughly 10,000 adjustments with no adverse effects (with exception of some post-treatment soreness).
eMJA: Manipulation of the cervical spine: a systematic review of case reports of serious adverse events, 1995–2001