Never let a chiropractor ever do anything except adjust the LOWER BACK on an ADULT.
See:
Chiropractic's Dirty Secret:
Neck Manipulation and Strokes
Stephen Barrett, M.D.
Stroke from chiropractic neck manipulation occurs when an artery to the brain ruptures or becomes blocked by a clot as a result of being stretched. The injury often results from extreme rotation in which the practitioner's hands are placed on the patient's head in order to rotate the cervical spine by rotating the head <1>. The vertebral artery, which is shown in the picture to the right, is vulnerable because it winds around the topmost cervical vertebra (atlas) to enter the skull, so that any abrupt rotation may stretch the artery and tear its delicate lining. The anatomical problem is illustrated on page 7 of The Chiropractic Report, July 1999. A blood clot formed over the injured area may subsequently be dislodged and block a smaller artery that supplies the brain. Less frequently, the vessel may be blocked by blood that collects in the vessel wall at the site of the dissection <2>.
Chiropractors would like you to believe that the incidence of stroke following neck manipulation is extremely small. Speculations exist that the risk of a serious complication due to neck manipulation are somewhere between one in 40,000 and one in 10 million manipulations. No one really knows, however, because (a) there has been little systematic study of its frequency; (b) the largest malpractice insurers won't reveal how many cases they know about; and (c) a large majority of cases that medical doctors see are not reported in scientific journals.
Published Reports
In 1992, researchers at the Stanford Stroke Center asked 486 California members of the American Academy of Neurology how many patients they had seen during the previous two years who had suffered a stroke within 24 hours of neck manipulation by a chiropractor. The survey was sponsored by the American Heart Association. A total of 177 neurologists reported treating 56 such patients, all of whom were between the ages of 21 and 60. One patient had died, and 48 were left with permanent neurologic deficits such as slurred speech, inability to arrange words properly, and vertigo (dizziness). The usual cause of the strokes was thought to be a tear between the inner and outer walls of the vertebral arteries, which caused the arterial walls to balloon and block the flow of blood to the brain. Three of the strokes involved tears of the carotid arteries <3>. In 1991, according to circulation figures from Dynamic Chiropractic, California had about 19% of the chiropractors practicing in the United States, which suggests that about 147 cases of stroke each year were seen by neurologists nationwide. Of course, additional cases could have been seen by other doctors who did not respond to the survey.
A 1993 review concluded that potential complications and unknown benefits indicate that children should not undergo neck manipulation <4>.
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The Bottom Line
As far as I know, most chiropractors do not warn their patients that neck manipulation entails risks. I believe they should and that the profession should implement a reporting system that would enable this matter to be appropriately studied. This might be achieved if (a) state licensing boards required that all such cases be reported, and (b) chiropractic malpractice insurance companies, which now keep their data secret, were required to disclose them to an independently operated database that has input from both medical doctors and chiropractors.
Meanwhile, since stroke is such a devastating event, every effort should be made to stop chiropractors from manipulating necks without adequate reason. Many believe that all types of headaches might be amenable to spinal manipulation even though no scientific evidence supports such a belief. Many include neck manipulation as part of "preventative maintenance" that involves unnecessarily treating people who have no symptoms. Even worse, some chiropractors—often referred to as "upper cervical specialists"—claim that most human ailments are the result of misalignment of the topmost vertebrae (atlas and axis) and that every patient they see needs neck manipulation. Neck manipulation of children under age 12 should be outlawed <33>.
More:
http://www.quackwatch.com/01QuackeryRelatedTopics/chirostroke.htmlSee also:
Chiropractic: Does the Bad Outweigh the Good?
Samuel Homola, D.C.
Many people go to chiropractors for relief of back pain. But there is reason for caution. Much of what chiropractors do is nonsense, and they often misinform their patients.
Do you need to see a chiropractor? Many people think they do. Just about everyone thinks of a chiropractor when back pain is mentioned. There is considerable evidence that spinal manipulation can help relieve some types of neck and back pain. But neck manipulation can be dangerous. And according to a study published in the October 8, 1998, New England Journal of Medicine, spinal manipulation may be no more effective than physical therapy in the treatment of back pain and only marginally more effective than following a self-help instruction booklet. So what about chiropractic treatment? <1> Should you—or any member of your family—ever go to a chiropractor?
There is no doubt that dramatic relief of back pain will occasionally occur when manipulation is used to unlock a binding spinal joint. Many people with acute or chronic back pain experience relief of symptoms when the spine is loosened by manipulation performed by a chiropractor, an osteopath, a physical therapist, or an orthopedist. Manipulation is most readily available from chiropractors, however, and a report issued by the RAND Corporation stated that 94% of all such manipulation in the United States is done by chiropractors <2>. For this reason, many people who have back pain will visit a chiropractic office where they will experience spinal manipulation for the first time.
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A 1996 RAND report on The Appropriateness of Manipulation and Mobilization of the Cervical Spine estimated that stroke and other injuries resulting from cervical spine manipulation occurred about 1.46 times per 1,000,000 manipulations <12>. It also concluded that only 11.1% of reported indications for cervical manipulation could be labeled appropriate. A patient who receives regular, frequent, and totally unnecessary neck manipulation is subjected to greater risk. Since many cases of stroke caused by cervical manipulation have not been recognized as such, studies are being done to determine how many stroke victims had neck manipulation prior to their stroke. The incidence of stroke from cervical manipulation might be much higher than indicated in past studies. A study by the Canadian Stroke Consortium, published in the July 18, 2000, Canadian Medical Association Journal, for example, reported that stroke resulting from neck manipulation occurred in 28% of 74 cases studied <13>. Other causes were sudden neck movement of various types. The most common finding was vertebral artery dissection (splitting or tearing of arterial walls with clot formation and embolism) caused by sudden movement or rotation of the top two cervical vertebrae.
<snip>
A good chiropractor can do a lot to help you when you have mechanical-type back pain and other musculoskeletal problems. But until the chiropractic profession cleans up its act, and its colleges uniformly graduate properly limited chiropractors who specialize in neuromusculoskeletal problems, you'll have to exercise caution and informed judgment when seeking chiropractic care.
More:
http://www.quackwatch.com/01QuackeryRelatedTopics/chiroeval.html
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