The Safety Of Chiropractic Cervical Spine Manipulation Based on 6 Recent Studies

Introduction:

Although it has officially been around since 1895, over the past 128 years, Chiropractic care has evolved from an ‘alternative’ to a mainstream system of healthcare commonly used for various musculoskeletal and other health conditions. For the purposes of this article, we will be focusing on chiropractic adjustment (aka Manipulation) of the neck for neck pain and headaches.  A common technique used by chiropractors is cervical spine manipulation, commonly known as a “neck adjustment.” However, concerns have been raised about the potential risk of stroke or arterial dissection associated with this procedure. In this blog post, we will delve into six studies, most of them recent, that provide valuable insights into the safety of chiropractic cervical spine manipulation. We’ll explore the findings of these studies, including the more recent evaluations, and their implications for patients seeking chiropractic care for neck-related issues. Let’s uncover the evidence and understand the safety and effectiveness of chiropractic neck adjustments.

Main Points of Each Article:

 Study 1

J Man Manip Therap (2023 Aug;31(4):261-269) Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers

• Measured vertebral artery (VA) length changes during cervical spine manipulation in human cadavers.
• VA elongated during manipulation but did not experience tensile force.
• Average VA length change during manipulation was 5.1%, and average elongation to mechanical failure was 51.3%.
• Failure forces ranged from 1.4 N to 9.7 N.
• Conclusion: Cervical spine manipulation appears to be a low-risk procedure for causing arterial dissection

Study 2

Chiropr Man Therap (2022 Jun 1;30(1):28) Kinematics of the head and associated vertebral artery length changes during high-velocity, low-amplitude cervical spine manipulation

• Measured angular displacements of the head and VA length changes during cervical spine manipulation.
• VA length changes during the thrust phase were small.
• Mean VA length changes were largest during rotation procedures.
• Conclusion: While some VA length changes occur during manipulation, the risk of arterial dissection appears to be low.

Study 3

J Manipulative Physiol Ther (2014 Jan;37(1):22-31) Changes in vertebral artery blood flow following various head positions and cervical spine manipulation

• Investigated the cerebrovascular hemodynamic response to cervical spine positions and manipulation.
• No significant changes in blood flow or velocity in the vertebral arteries were observed after head positions and manipulations.
• Conclusion: The evidence suggests cervical spine manipulation is unlikely to cause arterial dissection.

Study 4

J Manipulative Physiol Ther (2002 Oct;25(8):504-10) Internal forces sustained by the vertebral artery during spinal manipulative therapy

• Quantified the strains and forces sustained by the VA during spinal manipulative therapy (SMT).
• Strains during SMT were much lower than those required to mechanically disrupt the VA.
• Conclusion: SMT is an unlikely cause of VBA stroke.

Study 5

Chiropr Man Therap (2015 Jun 16;23:19)  Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations

• Conducted a case-control study to compare the association between chiropractic care and VBA stroke with primary care physician (PCP) care and VBA stroke in 1829 cases.
• Found no significant association between chiropractic visits and VBA stroke for both populations, regardless of age.
• Significant association observed between PCP visits and VBA stroke incidence, suggesting patients sought care for symptoms of arterial dissection.
• Conclusion: Chiropractic cervical spine manipulation is not significantly associated with an increased risk of VBA stroke. The positive association between PCP visits and VBA stroke is attributed to patients seeking care for symptoms such as headache and neck pain, which are associated with arterial dissection.

Study 6

Spine (Phila Pa 1976) (2008 Feb 15;33(4 Suppl):S170-5)  Examining vertebrobasilar artery stroke in two Canadian provinces

• Conducted an ecological study to determine the annual incidence of hospitalized VBA stroke and chiropractic utilization in Saskatchewan and Ontario between 1993 and 2004.
• VBA stroke incidence rates were 0.855 per 100,000 person-years for Saskatchewan and 0.750 per 100,000 person-years for Ontario.
• A significant increase in the incidence rate for Saskatchewan in 2000 (360% increase) and a smaller increase for Ontario (38% increase).
• Chiropractic utilization did not increase significantly during the study period in either province.
• Conclusion: At the ecological level, the increase in VBA stroke does not seem to be associated with an increase in the rate of chiropractic utilization.

Common Conditions Treated with Chiropractic Cervical Spine Manipulation (Adjustments): Chiropractic care is sought for various musculoskeletal issues affecting the neck and upper back. Some common conditions treated with cervical spine manipulation include:

• Neck Pain and Stiffness: Cervical spine manipulation can help alleviate neck pain and stiffness caused by poor posture, muscle strain, or injury.
• Headaches and Migraines: Chiropractic adjustments may offer relief for certain types of headaches, especially those originating from neck tension.
• Whiplash Injuries: After a car accident, whiplash injuries can cause neck pain and restricted movement, which chiropractic care may address.
• Cervical Disc Herniation: Chiropractors may use manipulation to reduce pressure on herniated discs in the neck and alleviate associated symptoms.

Conclusion: Based on a comprehensive review of six recent studies, it is evident that chiropractic cervical spine manipulation is generally safe and unlikely to cause arterial dissection or VBA stroke. The studies indicate that any association between chiropractic neck manipulation and stroke is more likely to be observed in patients already experiencing a stroke (Arterial Dissection) and seeking care for the symptoms of this condition in progress. These findings provide valuable insights into the mechanics and hemodynamic responses during manipulation, revealing low risks associated with this therapy. Consequently, the evidence consistently suggests that chiropractic cervical spine manipulation is a safe treatment option for patients seeking relief from neck-related issues. However, individual patient assessment and appropriate care by qualified chiropractors remain crucial for ensuring safety and efficacy. Patients can confidently consider chiropractic care as a viable option for managing neck pain and related conditions, knowing that the risk of stroke due to cervical spine adjustments is not supported by the findings of these studies. With proper evaluation and care, chiropractic cervical spine manipulation can be a beneficial approach to improving neck-related health concerns.

The Road to Recovery:

If you’re here in Miami or Miami Beach, the Road To Recovery from neck pain and headaches starts by calling Dr. Narson.  Dr. Narson (click for bio) is a chiropractic sports medicine specialist (DACBSP®) that will evaluate your injuries, design a program specific to your injuries and help get you enjoy being pain free again.

Click here to request an appointment with Dr. Narson

What If You’re Not In South Florida?

How to find a chiropractic sports medicine specialist if you’re not here in Miami Beach / Miami?  Go to https://www.acbsp.com/directory/ enter your location and you can find a DACBSP® or CCSP® near you that can help you with your sports injury!

Todd M. Narson, DC, DACBSP®, ICSC

Chiropractic Sports Medicine Specialist

Miami Beach Family & Sports Chiropractic Center

975 Arthur Godfrey Road #102

Miami Beach, FL 33140

Phone:  305.672.2225

Click here to request an appointment with Dr. Narson

References:

• Thomas M Kosloff, David Elton, Jiang Tao, Wade M Bannister, “Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations,” Chiropr Man Therap (2015 Jun 16;23:19), doi: 10.1186/s12998-015-0063-x, PMCID: PMC4470078.
• Eleanor Boyle, Pierre Côté, Alexander R Grier, J David Cassidy, “Examining vertebrobasilar artery stroke in two Canadian provinces,” Spine (Phila Pa 1976) (2008 Feb 15;33(4 Suppl):S170-5), doi: 10.1097/BRS.0b013e31816454e0, PMID: 18204389.
• Lindsay M Gorrell, Andrew Sawatsky, W Brent Edwards, Walter Herzog, “Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers,” J Man Manip Ther (2023 Aug;31(4):261-269), doi: 10.1080/10669817.2022.2148048, PMID: 36382347, PMCID: PMC10324446.
• Lindsay M Gorrell, Gregor Kuntze, Janet L Ronsky, Ryan Carter, Bruce Symons, John J Triano, Walter Herzog, “Kinematics of the head and associated vertebral artery length changes during high-velocity, low-amplitude cervical spine manipulation,” Chiropr Man Therap (2022 Jun 1;30(1):28), doi: 10.1186/s12998-022-00438-0, PMID: 35650649, PMCID: PMC9158147.
• Jairus J Quesnele, John J Triano, Michael D Noseworthy, Greg D Wells, “Changes in vertebral artery blood flow following various head positions and cervical spine manipulation,” J Manipulative Physiol Ther (2014 Jan;37(1):22-31), doi: 10.1016/j.jmpt.2013.07.008, PMID: 24239451.
• Bruce P Symons, Tim Leonard, Walter Herzog, “Internal forces sustained by the vertebral artery during spinal manipulative therapy,” J Manipulative Physiol Ther (2002 Oct;25(8):504-10), doi: 10.1067/mmt.2002.127076, PMID: 12381972.

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