I think Chirotalk has skewed opinions. They're usually people who are disgruntled by their college or they were not successful in business or subscribed to a philosophy which is antiquated. I even got sucked into reading this in my second year. but I equate this to fear-mongering on the less-knowledgable. Even patients who have become disgruntled with their own situations. It offers advice and discussion that is otherwise not verified.
I don't believe the spinal adjustment is for everyone, obviously there are screens and due diligences that every doctor must observe. Doctors must be aware of signs and symptoms of a stroke in progress (like dizziness, slurred speech, blurred vision, etc..) There are always a wide spectrum of competencies in every profession: Teachers, Lawyers, Doctors of Medicine, and Doctors Of chiropractic, etc....
The above mentioned papers cite research, yes, but take a close look at the populations they included in the study.. and take a look at the quality of study. The inclusion/exclusion criteria is not very strong. A paper only needed to be before 2000 to be included. That's basically 7 year old research at the time of publication. No real disqualifiers of any papers. Furthermore, they did not critique the quality of research the papers presented in the review. They also included manipulations done by NON-CHIROPRACTORS.. so basically people who have taken a weekend course and call themselves manipulators, as opposed to the 4 years post graduate study and constant training and evaluation and that chiropractors had gone through in Chiropractic College.
but let's also not forget that the numbers of adverse effects to Spinal Manipulation are essentially DROWNED out by the thousands of failed surgeries that must be repeated, or deaths on operating tables that happen every year. The risk of having a stroke from seeing a chiropractor is virtually the same as that of seeing a family doctor. Here's the source and abstract:
Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study.
Cassidy, J David DC, PhD, DrMedSc; Boyle, Eleanor PhD; Cote, Pierre DC, PhD; He, Yaohua MD, PhD; Hogg-Johnson, Sheilah PhD ; Silver, Frank L. MD, FRCPC; Bondy, Susan J. PhD
Study Design. Population-based, case-control and case-crossover study.
Objective. To investigate associations between chiropractic visits and vertebrobasilar artery (VBA) stroke and to contrast this with primary care physician (PCP) visits and VBA stroke.
Summary of Background Data. Chiropractic care is popular for neck pain and headache, but may increase the risk for VBA dissection and stroke. Neck pain and headache are common symptoms of VBA dissection, which commonly precedes VBA stroke.
Methods. Cases included eligible incident VBA strokes admitted to Ontario hospitals from April 1, 1993 to March 31, 2002. Four controls were age and gender matched to each case. Case and control exposures to chiropractors and PCPs were determined from health billing records in the year before the stroke date. In the case-crossover analysis, cases acted as their own controls.
Results. There were 818 VBA strokes hospitalized in a population of more than 100 million person-years. In those aged <45 years, cases were about three times more likely to see a chiropractor or a PCP before their stroke than controls. Results were similar in the case control and case crossover analyses. There was no increased association between chiropractic visits and VBA stroke in those older than 45 years. Positive associations were found between PCP visits and VBA stroke in all age groups. Practitioner visits billed for headache and neck complaints were highly associated with subsequent VBA stroke.
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.
I'll just leave you with one final thought....
How many people have had spine surgery on the wrong spinal segment? How many people have had knee surgery or hand surgery on the wrong side? How many people have had to go back for more surgery after having surgery for something that could have been solved with simple rehab?
I encourage everyone to search reputable sources, and not just discussion boards.. because who really is an expert? Not me, and not anyone else on this thread either.
Here's one conclusion from a paper in Spine, 33(2) 194-198.
Conclusion. There is a high prevalence of wrong level surgery among spine surgeons; 1 of every 2 spine surgeons may perform a wrong level surgery during his or her career. Although all spine surgeons surveyed report using at least 1 preventive action, the following measures are highly recommended but inconsistently adopted: direct preoperative communication with the patient by the surgeon, marking of the intended site, and the use of intraoperative verification radiograph.
