Greenwood Chiropractic - Safety of Chiropractic

The Safety of Chiropractic

The safety of any procedure, medical or chiropractic, is the first concern for the public safety. One wonders what this means when it comes to drug ads that end with a laundry list of side effects, including serious health problems and even death. Does chiropractic present any dangers to the public and if so, what are they?

The risk of chiropractic procedures has been the subject of much study. With millions of chiropractic adjustments given each and every day around the world it's important to the public, the profession and of course, the malpractice insurance companies. Because chiropractic has historically kept itself separate and unique from the medical profession it has found itself to be the object of attacks from medicine. Since evidence for the effectiveness of chiropractic in many health conditions continues to grow, the attack on chiropractic has moved to safety. What do the facts say regarding risk?

The most commonly attack on chiropractic is the claim that "manipulation of the neck" carries a risk of stroke or vascular injury to the arteries in the neck. Chiropractic has been around for over 100 years and this issue has been researched over and over again with the same conclusion.

Stroke is one of the leading causes of death in the U.S. The Center for Disease Control (CDC) reports that 700,000 people experience a stroke each year, and of these 160,000 are fatal. Risk of death from stroke also increases with age. Statistics reviewed between the years 1979 to 1991 found that the yearly incidence rates of death by stroke for those in the 25-44 years age bracket was only 3,418 deaths, whereas at the age of 65 or above, incidence rates increased to 140,938 deaths yearly.

Stroke is characterized by the sudden loss of circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Also called a "Cerebrovascular Accident" (CVA), stroke is a nonspecific term, which describes a cross-section of pathophysiologic causes, which include thrombosis, embolism, and hemorrhage.

Chiropractors are especially interested in strokes caused by CVA (cerebrovascular accident). There is an inherent risk of stroke in the general population. A certain number of people are going to have a stroke no matter where they are, even if they're just sitting on the couch reading a book. Approximately 1 in 430 people in the U.S. will have a stroke each year and stroke is the countries third leading cause of death (behind heart disease and cancer).

In 2005, NCMIC Insurance which provides malpractice insurance for over half of U.S. chiropractors publish a statement titled, "Current Concepts: Spinal Manipulation and Cervical Arterial Incidents 2005." It concludes in it's Executive Summary: "Unfortunately, opinion rather than fact has tended to dominate discussions regarding CVAs (cerebrovascular accidents) and chiropractic, even though there has been no definitive evidence that chiropractic adjustments actually cause strokes. The good news is that this monograph notes that a causative relationship between chiropractic manipulation and stroke is unlikely. There is an associative relationship between the two because people may go to chiropractors for relief of stroke-related symptoms."

So people with health problems go to the doctor or the chiropractor. That's not surprising. And sometimes and unhealthy person is in line for an imminent stroke (or heart attack or other catastrophic event).

A study published in the October 2, 2001 issue of the Canadian Medical Association Journal put this risk at one patient in 5.85 million. Here are a comparative risks for stroke and other catastrophic outcomes:

A note on NSAID's. In 1998, Dr. Singh of the Stanford University of Medicine reviewed the thousands of medical records of arthritis patients at 8 participating institutions. He concluded that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID are anti-inflammatory drugs that include Aspirin, Naproxen ("Aleve"), Ibuprofen ("Advil" and "Motrin")-related gastrointestinal (GI) complications (internal bleeding) and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures for all NSAID users would be overwhelming, yet the scope of this problem is generally un-reported and the public remains at significant risk.

Chiropractic adjustment of the neck is several thousand times safer than Aspirin. Another article entitled "36 Percent of Acute Liver Failures Are Linked to Acetaminophen" ("Tylenol") stated that other organ systems in addition to the liver are also compromised by the use of over-the-counter pain medications.

No one pays closer attention to injury statistics than Malpractice Insurance carriers. Scott Haldeman, MD, DC reviewed malpractice claims records for a 10-year period between 1988 and 1997. In reviewing the outcomes following the application of 134.5 million cervical manipulations (commonly referred to as the chiropractic adjustment), the records indicated that there were 23 reported cases of stroke or vertebral artery dissection (VAD). [ 10 ] Of this group, 10 of the patients had the complicating factors of high blood pressure, use of oral contraceptives, or a history of smoking, all of which are associated with vascular disease. The actual incidence of stroke or VAD following cervical manipulation was found to be one per 5.85 million cervical adjustments. That means that the average chiropractor would work for 1430 years (or practice 48 full chiropractic careers!) before they would see a single case of this type of incident.

The chart below shows the comparative risk of a number of common procedures and events to that of a chiropractic adjustment. Even the risk for stroke of something as common as birth control pills is over 200 times greater than a stroke from a chiropratcic adjustment.

Notice you are 7 times more likely to get hit by lightening! Other reports listing a higher frequency of adverse events have been compromised by the tendency of those authors to inappropriately list the practitioner as a chiropractor, even when it turned out that the injury was caused by a medical doctor, a physical therapist or even a kung fu teacher and a hair dresser! And yet the reports typically refer to the treatment as a "chiropractic adjustment."

The National College of Chiropractic Clinic reported that over a 15 year period over 5 million neck adjustments were given without a single vascular injury - and this is a student clinic with relatively inexperienced doctors performing the procedures.

Rather than raising concerns about the safety of chiropractic, these studies emphasize that spinal manipulation, in the hands of a in the hands of a trained chiropractor, spinal adjustment is extremely safe. However, in the hands of unskilled practitioners they can be dangerous, and the practice must be closely regulated. This is why chiropractic exists as a separate profession. To provide you with safe and effective care, not a physical therapist or a medical doctor who attended a weekend course on spinal manipulation (yes, they do have these). All chiropractors complete 2 years of pre-doctoral training followed by 4 years of doctoral training and a one year internship.

The American Journal of Pediatrics found that chiropractic is the most used alternative health care choice for children. One of the largest studies on chiropractic safety is the New Zealand Federal Government's 18 month "Inquiry on Chiropractic" published in 1979. The study concluded that "chiropractic is remarkably safe" and further stated that "chiropractic is the only health profession equipped by their education and training to carry out this procedure."

Dr. Philip Greenwood, D.C.
Murrieta, California