Is Chiropractic Safe?

Is Chiropractic Safe?
Dr. David L. Phillips
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YES! Definitely. Unequivocally. Unquestionably. Categorically. Undeniably.
Now that I have the superlatives out of the way, let me tell you the complete story…in the media of late, worldwide, there has been intense examination of this question as it relates to manipulation of the neck. I would like to discuss the issues behind this sudden outburst of negative publicity and see if I can’t dispel some myths.
Everything in life that you do has to be assessed as to its risks vs. its rewards. Getting into your car and driving to the store has its risks, but it sure beats carrying groceries in the rain. That’s the reward…convenience. Sure, some neck treatments are safer, but they don’t help much either. The reward of getting one’s neck manipulated (or adjusted, as we chiropractors call it) is that you derive enough benefit from the procedure to offset the risks. Cervical adjustments are fast, effective and mainly painless. Acute neck pain, chronic neck pain, whiplash, headaches, equilibrium disorders, arm pain and numbness and many other conditions all respond well to this type of treatment.
Can neck manipulation harm people? Yes, of course it can. Anything that can do good can also do harm. One of the side effects now being scrutinized in the media is the possibility of suffering a stroke after having your neck manipulated. Chiropractors, however, are not the only ones who perform neck manipulations. Lots of other professions do it too: physiotherapists, physiatrists, medical doctors, osteopaths, some massage therapists, and others. Is it safe? In the right hands, it is probably the safest medical procedure involving the neck. What is safer? Certainly not drugs, absolutely not surgery, not traction, not short wave, not passive exercise, not any of the common therapies that can be effectively applied to the neck.
There are numerous other scientifically valid connections between people’s necks and suffering a stroke. Such everyday activities as backing up your car, having your hair washed at a hairdresser/barber shop, painting a ceiling, sneezing, thrill rides at the fair, wallpapering, yoga, dental work, many sports activities, the list goes on and on. These have all been recorded as causes of strokes. Whenever you turn your head to an extreme, you theoretically stretch blood vessels within your cervical spine. Potentially, this momentary stretch can block or tear one of these vessels or dislodge a clot. We know that these occurrences are exceedingly rare, but they do happen. In the same manner, complications following neck manipulations are exceedingly rare.
So why are chiropractors being singled out? I’m sure there are many reasons for this unfair spotlight. Partly because we do more neck adjustments than anyone else, partly because we have always been the whipping boy of medicine. Partly because the media loves to sensationalize, partly because over the last few years we have attained great strides in acceptance, mainly for lower back pain, and everyone just assumed we were safe. And partly because there is a good deal of interprofessional jealousy over our domain and success of spinal care. Partly because of the knee-jerk fear in medical circles about the sudden rise of alternative medicine.
Typically, what seems to be happening is that when a person enters hospital with a stroke and mentions having seen a chiropractor recently, the attending medical personnel attribute blame to us. In many cases the time lapse between the chiropractic visit and the stroke symptoms can be an unreasonable period of time, days or weeks. They are not assessed for having been to a hairdresser or an air show or asked if they have painted a ceiling or backed up in their car recently, just “Have you been to chiropractor”.
Some of the attention is grossly unfair and even blatantly dishonest. In 1992, an Australian researcher complied a list of 430 what he called “cerebrovascular catastrophes” the majority of which he blamed on chiropractors. It turned out that he played fast and loose with his definition of the word ”catastrophe” and that only 50 cases could be fairly attributed to chiropractic. The rest were manipulations by some of the other professions listed above using techniques he called “chiropractic”. Considering that our profession is over 107 years old, 50 cases by any standard is remarkable. To put that number into perspective, the American Medical Association recently stated that the leading cause of death in the US is from drugs, and the third leading cause is from mistakes in hospitals.
So how often does harm result from chiropractic adjustment of the cervical spine? Recent studies have placed the risk ratio anywhere between 1 in 1.3 million to 1 in 6 million. Again, this is exceedingly low for any effective medical procedure. A revealing glimpse of the size of the problem can be seen by asking the firms that supply us with malpractice insurance. Someone already has, a researcher from Australia, a professor named Allan Terrett. He examined data from one of our largest insurers, NCMIC. This company covers 24,000 chiropractors for malpractice. Terrett found about 1 case in 2 million. So what does that number mean? It means that for every 25 chiropractors who practice full time for 40 years, one may see 1 case of stroke in his/her practice lifetime. In other words, the vast majority of us chiropractors practicing every day will never see any serious side effects from the neck treatments s/he delivers, and we won’t know any other chiropractor who will.