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article imageOp-Ed: Palmer Chiropractic ire to AHA's claim 'neck adjustments-stroke' Special

By Jonathan Farrell     Sep 13, 2014 in Health
Davenport - This past August, the American Heart Association issued statements to the press wishing to raise awareness of the potential risks when having a "neck adjustment" done by a chiropractor or other complimentary medicine professionals.
Doctors, Jose Biller, M.D. and Ralph Sacco, M.D. talked with this reporter by phone to discuss the details behind the recent statements. The official statements which mentioned the potential risk for stroke when administering a "neck adjustment" spurred officials at the Palmer College of Chiropractic to respond in rebuttal.
The condition Biller and Sacco said that they want to raise awareness of is called "Cervical Artery Dissection." Chiropractors refer to this as "Vertebral Arterial Dissection," the condition is basically, a damage to the layers of the artery walls in the neck, such as a small tear in the layers of artery. This could lead to stroke, noted the AHA.
Applying pressure, even if gently or a forcible and sudden movement to the neck would not be wise.
"We are not out to scold or get anybody," said Biller. "All we are trying to say is that Chiropractors, massage therapists and such should make it very clear to their patients that there are potential risks involved with a 'neck adjustment' treatment or maneuver."
"Also, this type of manipulation, said Biller we believe should not be utilized without fully discerning what the cause of the neck (or shoulder pain) might be. "Severe or chronic neck pain can be a sign of something that is not musculoskeletal in nature but more complex," said Sacco. "To jump to conclusions and perform the usual chiropractic neck adjustment would be a mistake, without taking the time to examine more closely what is the cause of the pain."
Looking to other symptoms such as dizziness, vertigo, nausea, jerky eye movements, slurred speech and so forth are also signs of ischemic stroke.
The release of the AHA statement caused a stir and continues to shed more light on the debate regarding "neck adjustments." On Aug. 8 the day after the AHA released its official statments, Christine Goertz, D.C., Ph.D., vice chancellor for research and health policy at Palmer College of Chiropractic, explained that medical doctors and doctors of chiropractic need to be vigilant in assessing patients who may be in the early stages of what she referred to as Vertebral Arterial Dissection (VAD). Speaking on behalf of Palmer and the view point of chiropractors, she noted. "And it’s also extremely important that the data regarding the risk of VAD is presented to patients in an accurate manner.
According to the Palmer Center for Chiropractic Research – the world’s largest chiropractic research center – the statement strongly implies a causal relationship between Chiropractic Manipulative Therapy and stroke – which isn’t substantiated by the best research available.
“The facts are that VADs are very, very rare events, and there’s absolutely no research that shows a cause-and-effect relationship between chiropractic care and stroke,” said Dr. Goertz. “Doctors need to be careful about how they counsel patients based on misleading statements, like this one from the American Heart Association.”
Chiropractic advocate and complementary medicine expert, Matthew McCoy DC, MPH, noted that the statements made by the AHA are "nothing new." He referred this reporter to one of several of his publications that explains in detail what he sees as a bias against complementary medicine. From his "Chronicle of Chiropractic, McCoy writes, "in this paper from the American Heart Association (what is said) in many ways it perpetuates the same old myths and reveals a basic ignorance regarding epidemiology." (Epidemiology means all things regarding the study of causes and effects of disease). McCoy noted that chiropractors like all medical and healthcare practitioners only seek to have the body heal itself.
Without question, both he and Goertz uphold that chiropractors like all health practitioners should be vigilant in recognizing the signs and symptoms of stroke. Yet as McCoy points out, "providers (chiropractors) are not causing the dissections but instead the patients are entering the doctors’ office with a dissection already in progress and it’s the signs and symptoms of neck pain and headache from the dissection that brought them there in the first place."
Even so, Biller who is the Chair of neurological research at Loyola University in Chicago, noted that studies as recent as 2007 pointed out that more people have been treated with this 'neck adjustment' in recent years. And that 7.5 percent of strokes are among the younger populations. The documentation of such studies goes back further, some to the 1990s. In 2002, a group of Canadian Neurologists affiliated with the Royal College of Physicians and Surgeons issued their concerns through an official warning to the public.
Dr. Goertz, mentioned recent studies and statistics. But noted in her speech that day there are many other factors that the AHA has not taken into account. "The focus on neck manipulation lacks context," Goertz said. “I am in total agreement that informed consent is a critical component of high-quality patient care,” Dr. Goertz said. “However, it is equally critical that what we tell patients is unbiased and evidence-based.”
Aside from the initial consciousness-raising, what Biller and Sacco did not clarify enough was the specifics. For this reporter found that when gathering data regarding stroke, the info can be subject to different variables, depending upon the approach and who is conducting the study. For example, according to the Agency for Healthcare Research and Quality, In 2005, there were an estimated 892,300 hospitalizations for cerebrovascular disease, totaling $8.5 billion in hospital cost. According to the agency's Healthcare Cost and Utilization Project report published in May of 2008, the 892,300 represented a hospitalization rate of 77.3 stays per 10,000 persons older than 45 years of age. Yet according to that report the stats were based mostly upon hemorrhagic forms of stroke and not ischemic. And, that study's focus was not so much on epidemiology but upon hospital costs.
According to publications like 'Science-Based Medicine,' "only one specific type of stroke, basilar stroke, has been linked to chiropractic." Yet, Science-Based Medicine also said in the same article that,"Carotid artery strokes have also been reported after chiropractic treatments." So, then the question must be asked, 'which type of stroke is it that is an issue with neck adjustments?'
It is not clear what other factors were involved in the types of cases which Science-Based Medicine mentioned as details are not presented. Even the literature presented by the AHA does not provide all the details. And, simply reading all the material is not easy for an everyday person to understand. Some studies like the one from the Journal of Manipulative and Physiological Therapeutics, say "spinal manipulative therapy is very unlikely to disrupt the vertebral artery." Yet it does not clarify "neck adjustment" as part of the study.
Christopher DeMartini, DC, DACNB of California Neurohealth, Redwood City specializes in neurological chiropractic care and advocates for greater awareness of head and brain injuries, especially in sporting and athletics. He noted that chiropractic by its very nature is always vigilant to any sign of a disorder or illness. especially, "involving the brain, spinal cord and nerves." Like Goertz, and McCoy, he too said that the study the AHA refers to is not conclusive.
While both Sacco and Biller acknowledged the study was not absolutely conclusive; "the rebuttal does not reflect the true reality that The association between cervical artery dissection and cervical manipulative therapies was identified in case control studies," Biller said.
"Once again, said Dr. Sacco who is a past-president of the AHA and currently, the Chair of Neurological studies at Miller School of Medicine at University of Miami, we are saying that the public should be made aware of this risk."
Dr. Ralph Sacco  MD of the Miller School of Medicine at University of Miami  Florida provides a vide...
Dr. Ralph Sacco, MD of the Miller School of Medicine at University of Miami, Florida provides a video presentation explaining why the AHA thinks neck adjustments may cause strokes.
Courtesy of American Heart Association
"Especially, prior to agreeing to any treatments," he said. Sacco also clarified that the AHA has simply made the statement because the AHA as a very large organization has a responsibility to cover all important health issues. With dozens of committees, councils and reviews that oversee lots of health subjects, "the AHA felt it was time." "The manuscript oversight committee recommended that this concern should be addressed," Sacco said.
"I’m sure neck manipulation and stroke are causally related somewhat, however rare they may be," said David Ressler, DC of Ressler Chiropractic of South San Francisco. He like many chiropractors and other complimentary medicine practitioners are accustomed to strict scrutiny by the medical establishment. "Walking across the railroad tracks is causally related to train deaths as well." "Unfortunately, he said, there isn’t a group trying to get everyone to stop crossing the train tracks." We do however educate people to the risks of crossing and how to look both ways. We also teach to never cross if the lights are flashing," he said. "There are those in medicine that want the lights flashing on chiropractic always." "But, he added, educated caution is probably the proper course at this time."
And educated caution is precisely what the AHA is trying to convey, regardless of which side of the debate a patient or practitioner is on.
For more information about the American Heart Association's concerns about neck adjustments or neck manipulation therapy, visit the web site of the American Heart Association
This opinion article was written by an independent writer. The opinions and views expressed herein are those of the author and are not necessarily intended to reflect those of
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