Stroke, Chiropractic, and the Annals of Internal Medicine | The Evidence Based Chiropractor

Chiropractic care and the risk of having a stroke. Is there a link? Or is it fake news?

Earlier this year, the Annals of Internal Medicine released a new research review which set to examine any possible link between cervical artery dissection (stroke) and chiropractic adjustments (spinal manipulation).

They also released a risk assessment strategy for all clinicians and doctors to use when examining patients who may be presenting with stroke-like signs and symptoms.

The paper, "A risk-benefit assessment strategy to exclude cervical artery dissection in manual spinal therapy: A comprehensive review," looked back at all of the literature around stroke and manual adjustments or manipulation. They found no direct causation between getting an adjustment and having a stroke. There's never been any literature to support causation.

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Why is there so much confusion?

The researchers believe it may start with the patients presenting symptoms. The symptoms that cause many people to visit a chiropractor (neck pain, headache, etc.) are also some of the most common symptoms associated with a stroke in progress. So how can you tell the difference?

Let's take it from the top.

A cervical artery dissection occurs when a tear in the internal carotid or vertebral artery results in an intradural hematoma, aneurysm, or dilation. The incidence of cervical artery dissection is very low at less than 3/100,000 people per year.

Cervical artery dissection incidence is less than 3/100,000 people per year

There isn't a practicing chiropractor that hasn't been asked about the possible link between stroke and adjustments. Why? It's believed that overzealous neurologists may be a primary factor. Historically, they have produced a majority of the case reports which attempt to "prove" an adjustment caused a stroke. However, these case reports are highly subjective, have never been able to prove causation, and contain none of the data needed to show a link between the adjustment and the stroke.

I don't believe it's because neurologists don't like chiropractors, but these case reports (which are extremely rare) are very sensational and often are picked up by news organizations and discussed as if it was a randomized clinical trial.

Previous research has shown that the probability of a stroke is the same if you see a chiropractor or a primary care doctor. As such, there's no established causation between cervical spine manipulation and an increased risk of a cervical artery dissection.

Here are a few key findings from this paper:

"The World Health Organization regards manual mobilization and or spinal manipulative treatment conducted by chiropractors to be a safe and effective treatment with few mild transient effects."

"several extensive cohort studies and meta-analysis have found no excess risk of CAD, resulting in secondary ischemic stroke for chiropractics empty compared to primary care follow up."

"History taking, especially regarding the time of symptom onset is the single most important factor for detecting subtle symptoms of a CAD."

As we continue to understand more about identifying a potential cervical artery dissection, it seems as though a thorough history is critical.

Chiropractors, primary care doctors, and orthopedic specialists all learn a variety of orthopedic tests to be used as a screening tool for CAD. Unfortunately, these orthopedic tests are not very reliable or sensitive. The latest literature indicates that using history taking assessment tool may be a much better option than these antiquated tests to determine CAD.

The assessment begins with classifying environmental risks and inherited risks. A few examples of environmental risks would be a recent acute infection, vitamin deficiency, low body mass index, low cholesterol, or smoking. Examples of inherited risks are a medical history of arterial anomalies, fibromuscular dysplasia, connective tissue disorders, etc.

This assessment strategy is a fantastic tool because it can be used as a step by step guide to identify patients at risk and make better medical decisions.

Click here to see the paper on PubMed and access the entire assessment strategy

We highlighted this research for members of The Evidence Based Chiropractor as their research brief in April. Our docs use it as a way to build trust, build relationships, and build referral network with other healthcare providers in their community.

Get a FREE Chiropractic & Stroke Research Brief

One of the most significant concerns that many medical doctors have with chiropractic revolves around safety. You can overcome this friction through education and outreach. That's why I'd encourage you to become a member of The Evidence Based Chiropractor. We focus on bridging the gap and helping you build referral relationships.

The Healthcare "Secret" of Pro Athletes

Professional sports is a high stakes game, where even the slightest advantage can make the difference between winning and losing. Most high-level athletes are in tune with every nuance of their body and remain on the constant hunt to find ways to improve their performance.

In addition to a lot of practice and talent- many athletes have relied on chiropractic care as a “secret” ingredient to their success.

From Babe Ruth to Tom Brady- top athletes have been using chiropractic for decades.

Why it Matters:

You don’t need to be a pro athlete to desire improved health and well-being. Almost all of us are interested in decreasing pain, improving function, and increasing our strength. New research has showcased that chiropractic care may be able to help in all three of those areas.

- In a recent study, athletes had increased strength for up to 30 minutes after a chiropractic adjustment

- Chiropractic adjustments have been shown to provide more significant pain relief than commonly prescribed NSAID’s

- Even people with moderate or severe pain have experienced significant functional improvement with chiropractic

Next Steps:

Whether you are a weekend warrior, traveling every weekend for youth sports, or just looking to enjoy a higher quality of life- chiropractic care may be right for you. Finding relief from pain, improving your functional abilities, and increasing your strength and endurance are all essentials parts of having a high quality of life. Even if you aren’t currently competing to win a world championship, you probably have a few healthcare goals in mind. Let us know what they are, we would love become part of your “secret” to success.

Science Source:

The effects of a single session of spinal manipulation on strength and cortical drive in athletes. European Journal of Applied Physiology 2018

Spinal high-velocity low amplitude manipulation in acute nonspecific low back pain: a double-blinded randomized controlled trial in comparison with diclofenac and placebo. SPINE 2013

The Chiropractic Outcome Study: pain, functional ability and satisfaction with care. JMPT 1997

Spinal Injections Can be Back Breaking

Spinal injections have been shown to increase your risk of spinal fracture.

Did you know that recent research says that treatments like spinal injections can dramatically increase your risk of a cracked, or broken back? The scary part is over 9 million of these injections are given every year for spinal pain! New research has shown a 21% increased risk of a spinal fracture after every epidural steroid injection.

Lumbar epidural steroid injections are frequently given by pain management doctors for the treatment of radiculopathy or neurogenic claudication arising from compression of spinal nerves. However, there is evidence suggesting that corticosteroids can negative affect bone strength by diminishing new bone formation and increasing bone resorption.

The findings suggest that steroid injections can lead to increased bone fragility. The added exposure to glucocorticoids resulting from these injections may carry a greater risk than the medical industry previously thought.

“Of greater concern, the definable fracture risk as documented by Mandel et al. should be set against the best available evidence regarding the long-term efficacy of these interventions, which is admittedly less than robust.” - Andrew J Schoenfeld, MD

Why it Matters:

As you can imagine, spinal fractures hurt. They require further medical treatment and sometimes even result in surgery. By staying conservative with your healthcare, you can reduce your risks and get the relief you desire. Research shows spinal adjustments as one of the best forms of care to reduce your pain, increase your function and improve your overall quality of life.

Chiropractors are focused on correcting the cause of your pain. Problems with your spine can put pressure on your discs and nerves causing irritation, swelling, and a lack of spinal motion. A shot does not correct the cause of the pain, at best it only temporarily masks it. With the risks of spinal fractures, the smart decision is to get well and stay well using conservative, natural healthcare.

▪ Research has shown a 21% increased risk of spinal fractures after injections

▪ A fracture, or broken back, can cause tremendous pain and even result in surgery

▪ Natural healthcare, such as chiropractic, is recommended before moving on to riskier treatments such as spinal injections

Next Steps:

Share the science. Being well informed comes with the responsibility of sharing what you know with others who don’t. That doesn’t mean you should argue with those who are already convinced by their prejudices. It says that we encourage you to share what you know with others who are curious and can benefit from understanding the Research That Matters.

Science Source:

Spinal Manipulation Postepidural Injection for Lumbar and Cervical Radiculopathy: A Retrospective Case Series. Journal of Manipulative and Physiological Therapeutics. September 2004

Symptomatic MRI-Confirmed Lumbar Disk Herniation Patients: A Comparative Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched Cohorts Treated with Either High-Velocity, Low Amplitude Spinal Manipulative Therapy or Imaging-Guided Lumbar Nerve Root Injections. Journal of Manipulative and Physiological Therapeutics. May 2013

A Retrospective Analysis of Vertebral Body Fractures Following Epidural Steroid Injections. The Journal of Bone & Joint Surgery. June 2013

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What is Foam Rolling and why does it hurt so good?

Chiropractic, foam rolling, and your body.

Foam rolling has exploded in popularity over the past few years. No longer used only by athletes and trainers, foam rolling (or myofascial release) is now used by people with all levels of fitness. The goal of foam rolling is to improve muscle function, performance, and range of motion. When a tight muscle or trigger point is released, you are able to move freely, with less pain, and improve your overall performance.

Why it Matters:

Activity, age, and injuries can cause your muscles to lose flexibility which in turn creates adhesions and pain. Foam rolling allows you to place deep compression on these areas reducing pain and adhesions while creating an improved joint range of motion. Using a foam roller during your warm-up routine may provide additional benefits beyond stretching alone. New research has discovered that foam rolling can improve flexibility more than static and dynamic stretching.

- Foam rolling is designed to release tight muscles and trigger points

- Researchers have found increased flexibility and reduced pain after foam rolling

- Proper movement patterns are thought to improve performance and reduce injury

Next Steps:

Using a foam roller on tight muscles and trigger points has been shown improve flexibility and help maintain proper movements patterns. If you have questions on whether foam rolling is right for you, just ask! We believe this type of at-home care is a great way to support the adjustments and care you receive in our office.

Science Source:

Acute Effects of Foam Rolling, Static Stretching, and Dynamic Stretching During Warm-ups on Muscular Flexibility and Strength in Young Adults. Journal of Sports Rehabilitation 2017

Differences in pressure pain threshold among men and women after foam rolling. Journal of Bodywork and Movement Therapies 2017

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How to Reduce Crossfit Injuries

If you’re into Crossfit, you know how addictive it can become. That mix of high-intensity interval training and competition can help drive your motivation and commitment and lead you to achieve amazing changes to your body. That consistency becomes the key to your success - to getting the results you're after, but what do you do when you're injured?

Preventing Crossfit Injuries 

Injuries often occur when your body doesn’t have the correct balance of strength and flexibility. Muscles tears, sprain and strains, and even painful arthritic changes can flare up for a number of reasons, such as attempting to lift too much weight at once or not having enough flexibility to support that weight through a full range of motion. How can you reduce your likelihood of injury? Researchers have discovered that a combination of proper warm up/cool down, a full range of motion and progressive intensity training can help reduce injuries when strength training.  

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• Take a few minutes to stretch before and after your workout.

• Increase the weight you lift slowly and focus on quality reps vs. max weight.

• Use good posture and ergonomics during your workouts - don’t “cheat” and increase your risk of injury.

 

One of the most effective ways to improve your spinal mobility and flexibility is through Chiropractic care. Adjustments to your spine and extremities have been shown to increase their range of motion and may help you find that perfect balance of strength and flexibility.

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Short-term effect of spinal manipulation on pain perception, spinal mobility, and full height recovery in male subjects with degenerative disk disease: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2014. Progressive resistance strength training and the related injuries in older adults: the susceptibility of the shoulder. Aging Clinical and Experimental Research 2014.