In the past 6 months I have ordered more studies to investigate the arterial structures of the neck than I have in the last several years. What was I looking for?
This is not a new issue, we discussed this issue openly in 2000-2003 when I attended the Los Angeles College of Chiropractic and we were told that we could, in very rare instances (“1 in a million” was the phrase), be the causative factor in vertebral artery dissection. This led to some students declaring that these tragedies could NEVER happen in their offices as their technique was too pure, lacking in rotation specifically. (I tend to limit rotation, myself, as necks can normally rotate 90 degrees and very rarely get stuck in rotation.). Throughout the early 2000’s I heard that some chiropractic curriculum actually stopped teaching rotary techniques involving the neck to limit these crises.
In the last decade the profession actually studied the biomechanics of manipulative techniques on vertebral arteries, which run through the spinal column in the neck to provide blood to the brain and spine. According to the most current research not only do we NOT generate enough force to tear a healthy artery an already torn artery presenting to our offices will not be made worse with a Chiropractic adjustment (Canine studies: they cut little doggy arteries and then manipulated the pooches neck). Turning your neck to back your car out of your driveway produces more stress on your vertebral artery than an adjustment. This evidence has changed my views from when I started in my learning and career.
In other words, as the science changed, so did my beliefs. (Hint: This is how science is supposed to work.)
That being said, what the hell happened to this young woman after her adjustment.
Spontaneous dissection of the vertebral artery (without trauma) happens in 1-1.5 people out of 100,000 people (Carotid artery spontaneous artery dissection is 2 out of 100,000). Before stroke sequela becomes severe enough to require hospitalization initial symptoms usual include headaches and neck pain. This alone drives people to seek all forms of palliative relief, including Chiropractic. Making matters worse is that misdiagnosing of strokes in Emergency Rooms happens an estimated 15,000-165,000 in the United States alone every year.
Doing the math… with 70,000 Chiropractors (in the US) doing dozens of adjustments a day what’s the possibility that one of the unlucky 1 in 100,000 presents to a chiropractic office with vague symptoms of neck pain and a headache experiencing a serious condition that trained emergency rooms miss thousands of times a month?
When these tragedies occur it descends into a shit storm: Chiropractics detractors declaring that we are a bunch of dangerous quacks playing with fire while Chiropractic supporters declaring that we are miracle workers and these instances are “rare” and the results of bad apples within the profession.
I really wish it was that simple, that bad technique and bad apples were solely responsible for this but that’s what scares the shit out of me the most: Being a good adjustor with low rotation means NOTHING. These unfortunate souls who are going to have spontaneous VAD’s are going to have a stroke whether they are in the hair salon or the restaurant OR they just might enter into my care where my careful technique won’t mean shit. Just my ability to discern something being a little off and trusting my spidey sense enough that this particular patient is NOT like the routine patients I commonly see. Does this healthy looking person have any risk factors (smoking, particular NSAIDS, certain antibiotics, both the “natural and synthetic” spike proteins rolling around the planet) leading to collagen degradation in a thin layer of the vascular epithelium that these routine symptoms mean they are a ticking time bomb?
Well you get the picture.
Vertebral artery dissections post chiropractic adjustment are the school shootings of the medical world: statistically rare, unfortunately increasing, traumatic and prone to a group defensively declaring after the horror that they aren’t doing anything wrong.
Chiropractors need to proactively be open and honest about this issue because the causative factors that degrade the vascular epithelium are increasing. There will be a general rise in these cases and that larger pool of people Will enter our offices. We need to up our diagnostic skills, specifically focused neurological and vascular exams as we are now held to a higher standard than the “Real Doctors” who miss these events.
Yes it sucks that public health agencies and magazines like people have normalized each and every death in the “Healthy and young” over the last year to turn around and forget the correlation/causation debate.
Yet bitching about the hypocrisy isn’t going to protect our patients or ourselves.
Chiropractic Rōnin 