Last Thursday the Daily Mail wrote an outrageous article about the safety of cervical adjustments but it appears they haven’t done a very good job with their research! Chiropractic adjustments to the cervical spine is safer than taking asprin, crossing the road and visiting your hairdresser! You have more chance of being hit by lightning !!
Please read our Association’s response (which the Daily Mail refuses to print!)
‘Chiropractic Care is Safer than going to the Hairdressers!’
Further to a recent article published in the Daily Mail entitled “Letting a chiropractor ‘crack’ your neck to ease pain could trigger stroke” the United Chiropractic Association would like to address the content of this article and provide the research and references that the authors of the BMJ statement chose to ignore.
Research by Alan Terret et al., highlights the rate of iatrogenic problems associated with spinal manipulative therapy as rendered by doctors of chiropractic is only 1 in 5.85 million cases, which is less than the chance of stroke in a hair salon or being hit by lightning (one in 600,000). It equated to one occurrence in 48 chiropractic careers. (1)
“We didn’t see any increased association between chiropractic care and usual family physician care, and the stroke,” said Frank Silver, one of the researchers and also a professor of medicine at the University of Toronto and director of the University Health Network stroke program. (2)
If we were to take a look at the rates of iatrogenic deaths from medical care, the numbers are staggering. Barbara Starfield, MD, MPH, of the Johns Hopkins School of Hygiene and Public Health, reported that medical care is now the third-leading cause of death in the U.S., causing 225,000 preventable deaths every year. (3)
In 2006, Jay Triano, DC, PhD, wrote about the stroke issue in his publication, Current Concepts in Spinal Manipulation and Cervical Arterial Incidents, that included 675 references and a comprehensive discussion of cervical artery injury and manipulation. He also came to the sobering conclusion that chiropractic is very safe:
- The increased risk of death resulting from NSAID use is 1,500 times greater than the risk of tetraplegia following cervical SMT.
- On analysis, SMT as delivered by chiropractors is one of the most conservative, least invasive and safest of procedures in the provision of health care services.
- The risks of SMT pale when compared to known medical risks. Chiropractors, by their training and skill in SMT and special emphasis on the spine, are the best positioned to deliver this mode of health care to the public.
- Conclusion: VBA 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. 
A study by Anthony Rosner, PhD, comparing medical procedures to chiropractic care concerning strokes flipped this coin to mention patients need to be warned of the dangers of medical procedures rather than chiropractic care. As he suggests, “The statistics really begin to spin one’s head.” (5)
Using a baseline figure of one per one million as an estimate of stroke incidence attributed to cervical manipulations, one finds a:
- two times greater risk of dying from transfusing one unit of blood; (6)
- 100 times greater risk of dying from general anesthesia; (7)
- 160-400 times greater risk of dying from use of NSAIDs; (8)
- 700 times greater risk of dying from lumbar spinal surgery; (9)
- 1000-10,000 times greater risk of dying from traditional gall bladder surgery; (10)
- 10,000 times greater risk of serious harm from medical mistakes in hospitals. (11)
Obviously these medical risks are unknown by the public and untold by the medical propagandists to the media, yet the same medical professionals who criticized chiropractors forget to mention these facts (a case of “professional amnesia” as Dr. Rosner suggests) of the remote danger of manipulation or the fact that patients who seek medical care are equally susceptible, if not more so, to medical mistakes and iatrogenic problems.
Despite the overwhelming support for chiropractic manipulation for neck problems, the medical misinformers have again raised unwarranted concern for strokes caused by manipulation. A 2010 study from England, “Deaths After Chiropractic: A Review Of Published Cases,” by Edzard Ernst of the Medical School at the University of Exeter, once again raised the level of fear over chiropractic care when he noted that “Twenty-six fatalities were published since 1934 in 23 articles.” (12)
Considering this covers 76 years and equates to 0.34 deaths per year, instead of sounding an alarm to scare people as Ernst attempted, he should have praised chiropractic care for its obvious safety since this is an extremely low rate in comparison with equivalent medical methods for the same diagnostic condition.
Ernst’s paper drew quick criticism from leading medical and chiropractic scholars. According to SM Perle, S French, and M Haas:
Ernst ignored the evidence against a causal relation between spinal manipulation and death. Instead, he went boldly along a path of fear mongering and propaganda that we expect was predetermined to establish the dangers of CSM (cervical spinal manipulation). (13)
Another review from The Dartmouth Institute for Health Policy and Clinical Practice was equally critical:
Three deaths were reported during the last 10 years of the study, so for that most recent time period, the absolute risk could be estimated to be 3/10 per 100 million, or three deaths for every billion chiropractic encounters…This rate is so low that it cannot possibly be considered significant…An interesting flip side to the research question might be: by undergoing a course of chiropractic spinal manipulation, how many patients were able to avoid death by avoiding complications of surgical
According to this report, Letting chiropractor ‘crack’ your neck to relieve pain could trigger stroke, “Physiotherapy lecturer Neil O’Connell, of Brunel University, Uxbridge, and colleagues have warned that cervical spine manipulation ‘may carry the potential for serious neurovascular complications.’ Writing online in the British Medical Journal, they added that the technique is ‘unnecessary and inadvisable.’”
Most interesting is the lack of proof-where are the injured patients? Nowhere to be found. Where is the scientific proof, not merely conjecture by biased medical personnel, that manipulation “may carry the potential for serious neurovascular complications”? Nowhere again to be found in this article. Where are the counterpoints made by the chiropractic researchers and educators? Nowhere in this article. Indeed, where is the “fair and balanced” reporting on this issue?
The New Zealand government convened a Commission of Inquiry into Chiropractic in 1978-79 and commented on the alleged harm done by chiropractors:
”The conspicuous lack of evidence that chiropractors cause harm or allow harm to occur through neglect of medical referral can be taken to mean only one thing: that chiropractors have on the whole an impressive safety record.”
Much of this material is an excerpt from Chiropractors for fair Journalism by JC Smith, MA, DC. www.
(1) AGJ Terret, “Current Concepts in Vertebrobasilar Complications Following Spinal Manipulation,” NCMIC Group Inc, West Des Moines, Iowa, (2001)
(2) G Bronfort, M Haas, R Evans, G Kawchuk, and S Dagenais, “Evidence-informed Management of Chronic Low Back Pain with Spinal Manipulation and Mobilization,” Spine 8/1 (January-February 2008):213-25.
(3) B Starfield, “Is US Health Really the Best in the World?” JAMA 284/4 (July 26, 2000):483-485.
(4) John J. Triano, Current Concepts in Spinal Manipulation and Cervical Arterial Incidents by (Jan 1, 2006)
(5) A Rosner, “Evidence or Eminence-Based Medicine? Leveling the Playing Field Instead of the Patient,” Dynamic Chiropractic 20/25 (November 30, 2002)
(6) J Paling www.healthcare speaker.com, 2000.
(7) Paling, ibid.
(8) V Dabbs, W Lauretti. “A Risk Assessment Of Cervical Manipulation Vs NSAIDs For The Treatment Of Neck Pain,” Journal of Manipulative and Physiological Therapeutics 18/8 (1995):530-536.
(9) RA Deyo, DC Cherkin, JD Loesser, SJ Bigos, MA Ciol, “Morbidity and Mortality In Association With Operations On The Lumbar Spine: The Influence Of Age, Diagnosis, And Procedure,” Journal of Bone and Joint Surgery Am 74/4 (1992):536-543.
(10) Paling, ibid.
(11) Paling, ibid.
(12) E Ernst “Deaths After Chiropractic: A Review Of Published Cases,” Int J Clin Pract, 64/8 (July 2010):1162-1165
(13) SM Perle, S French, and M Haas, “Critique of Review of Deaths after Chiropractic, 4″ Letters to editor, The International Journal of Clinical Practice, 65/1 (January 2011):102-106.
(14) JM Whedon, GM Bove, MA Davis, “Critique of review of deaths after chiropractic, 5″ Letter to editor, The International Journal of Clinical Practice, 65/1 (January 2011):102-106.