By Dennis Thompson

HealthDay reporter

THURSDAY, Aug 7, 2014 (HealthDay News) – Having a chiropractor or osteopathic doctor adjust your neck may be linked to an increased risk of stroke, according to a scientific statement from the American Heart Association.

The energetic thrusts and rotations sometimes used in neck manipulation can cause a small tear in the arterial walls in the neck, a condition known as cervical artery dissection.

A tear in the artery wall can lead to a stroke if a blood clot forms in the area that later breaks off to block a blood vessel in the brain.

Such a tear “occurs with sudden movement that can stretch or twist the neck, such as occurs during whiplash or sporting events, or even when coughing or vomiting violently,” said the author of the statement, Dr. Jose Biller, Chair of Neurology at Loyola University Chicago Stritch School of Medicine. “The techniques for manipulating the cervix, although different among health professionals, include a rotation of the neck and sometimes a forceful push.”


These artery wall injuries are a major cause of strokes in young and middle adults and account for 8 to 25 percent of strokes in patients under 45, according to the authors in the Supporting Information.

Four large studies have found a link between neck manipulation and stroke in patients up to 45 years of age, although evidence lacks evidence that practice can directly cause stroke, the paper said.

Still, chiropractors and osteopathic doctors should warn patients about this link, the statement added.

“We are of the firm belief that patients should be informed about this connection before neck manipulation,” said Biller.

The statement was published in the online August 7th edition of Stroke magazine.

Chiropractors are aware of the link between neck manipulation and stroke, which has been a problem for about five years, said Keith Overland, past president of the American Chiropractic Association and a chiropractic doctor in Norwalk, Conn.

But Overland said the evidence remains mixed and inconclusive.


“Two recently published studies have found that there is no evidence that the force or direction used in manipulating the cervix reaches the threshold of stretching the arteries to the point where they can be damaged,” he said, adding that neck fit professionals use violence “no greater than what people can do in activities of daily living”.

Overland added that neck manipulation has been linked to far fewer stroke deaths than other common medical treatments for neck pain.

Neck manipulation has been linked to about one death per 1 million people from cervical artery dissection, he said.

For comparison, nonsteroidal anti-inflammatory drugs (NSAIDs) cause 153 stroke deaths per 1 million people, narcotics cause 53 stroke deaths per 1 million people, and spinal surgery on the neck causes 500 stroke deaths per 1 million people, Overland said.

“We are concerned that such a statement may create anxiety in a patient and prevent them from making a range of treatments that will actually prove to be the safest choice for neck pain or headache,” he said.


In a statement released Thursday, the American Osteopathic Association had the following to say about the new statement: “US-trained osteopathic physicians [DOs] Use osteopathic manipulative therapy to diagnose, treat, and even prevent any disease or injury. DOs are taught to perform thorough assessments using standard neurological and orthopedic exams. “

The statement noted that osteopaths should not be grouped together as chiropractors and physical therapists who are not doctors and who use different techniques for cervical manipulative therapy.

Biller found that the link between neck adjustments and stroke is difficult to assess. People who have previously suffered a ruptured artery may receive treatment for neck pain relief. This is a common symptom of cervical artery dissection, which can precede a stroke by several days.

Because of this, all health professionals – including chiropractors and osteopaths – should be on the lookout for stroke risk factors that occur in patients seeking help with neck pain or chronic headaches, he said.

Overland agreed, adding that chiropractors should discuss the potential stroke risk of neck manipulation with any patient who has other risk factors for stroke, such as: B. cardiovascular diseases, familial stroke diseases or severe headaches.


For the same reason, chiropractors shouldn’t necessarily discuss stroke risk with someone without other risk factors, he added.

“If someone came up from basketball and has a muscle in their neck but is otherwise perfectly healthy, we don’t see any relationship or risk there,” said Overland. “The discussion should be based on thorough examination.”