The short answer is that you can have a stroke while doing anything, including before, during or immediately after Chiropractic treatment. A number of case control studies have suggested an association between chiropractic neck manipulation and cervical artery dissection (CAD), but a causal relationship has never been established. This study from 2016 reviewed 253 published articles on the subject and found that:
There is no convincing evidence to support a causal link between chiropractic manipulation and CAD (strokes). Belief in a causal link may have significant negative consequences such as numerous episodes of litigation.
So why is chiropractic associated with strokes? The same article also had this to say:
This relationship may be explained by the high risk of bias and confounding in the available studies, and in particular by the known association of neck pain with CAD and with chiropractic manipulation.
Perhaps the greatest threat to the reliability of any conclusions drawn from these data is that together they describe a correlation but not a causal relationship, and any unmeasured variable is a potential confounder. The most likely potential confounder in this case is neck pain. Patients with neck pain are more likely to have CAD (80% of patients with CAD report neck pain or headache), and they are more likely to visit a chiropractor than patients without neck pain.
What does this mean? This graph published by the same study sums it up nicely.
Here is a great example of what the article is referring to: A potential patient is having neck pain. They decide to seek Chiropractic treatment because of their neck pain. However, their neck pain is not caused by a muscoskeletal injury (something chiropractors can treat,) but is actually caused by the stroke that they are having. Basically, the patient was having a stroke that was causing the neck pain before they even walked into the chiropractic office. If the patient received Chiropractic treated for their neck pain, then the Chiropractor may get blamed for causing the patients stroke (even though the patient was already having a stroke before receiving the treatment.) Thankfully, because strokes can cause neck pain in 80% of patients, Chiropractors are trained to screen for strokes prior to treatment.
Therefore, since there is no evidence that Chiropractic manipulation causes strokes, what is responsible for a patient having a stroke? The Mayo Clinic’s website identifies a number of different possibilities, including lifestyle and medical risk factors:
Lifestyle risk factors
- Being overweight or obese
- Physical inactivity
- Heavy or binge drinking
- Use of illicit drugs such as cocaine and methamphetamines
Medical risk factors
- Blood pressure readings higher than 120/80 millimeters of mercury (mm Hg)
- Cigarette smoking or exposure to secondhand smoke
- High cholesterol
- Obstructive sleep apnea
- Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm
- Personal or family history of stroke, heart attack or transient ischemic attack.
There are other factors that the Mayo Clinic identifies as well:
Age —People age 55 or older have a higher risk of stroke than do younger people.
Race — African-Americans have a higher risk of stroke than do people of other races.
Sex — Men have a higher risk of stroke than women. Women are usually older when they have strokes, and they’re more likely to die of strokes than are men.
Hormones — use of birth control pills or hormone therapies that include estrogen, as well as increased estrogen levels from pregnancy and childbirth.
If you follow the link to the Mayo Clinic website listed above, please notice something. In the entire article “Chiropractic” and “manipulation” are not mentioned. The National Stroke Association, The American Stroke Association, and The National Heart, Lung, and Blood Institute websites all include great information on strokes and all of them do not mention “Chiropractic” or “Manipulation” as risk factors. This is because there are many know risk factors for strokes, but Chiropractic treatment is not one of them.
What can be done to prevent strokes? According to the National Heart, Lung, and Blood Institute website, reducing the risk factors mentioned above is one of the best ways:
- Be physically active. Physical activity can improve your fitness level and health. Talk with your doctor about what types and amounts of activity are safe for you.
- Don’t smoke, or if you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise your risk of stroke. Talk with your doctor about programs and products that can help you quit. Also, secondhand smoke can damage the blood vessels.
- Aim for a healthy weight. If you’re overweight or obese, work with your doctor to create a reasonable weight loss plan. Controlling your weight helps you control risk factors for stroke.
- Make heart-healthy eating choices. Heart-healthy eating can help lower your risk or prevent a stroke.
- Manage stress. Use techniques to lower your stress levels.
The signs and symptoms of strokes can occur very quickly. It is important to recognize these signs and seek emergency medical attention immediately. If you notice any of these symptoms mentioned by the NHLBI website, call 9-1-1 immediately.
- Sudden weakness
- Paralysis (an inability to move) or numbness of the face, arms, or legs, especially on one side of the body
- Trouble speaking or understanding speech
- Trouble seeing in one or both eyes
- Problems breathing
- Dizziness, trouble walking, loss of balance or coordination, and unexplained falls
- Loss of consciousness
- Sudden and severe headache
The website also states:
A transient ischemic attack (TIA) has the same signs and symptoms as a stroke. However, TIA symptoms usually last less than 1–2 hours (although they may last up to 24 hours). A TIA may occur only once in a person’s lifetime or more often.
At first, it may not be possible to tell whether someone is having a TIA or stroke. All stroke-like symptoms require medical care.
If you think you or someone else is having a TIA or stroke, call 9–1–1 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts.
In conclusion, there is no evidence that suggests that Chiropractic manipulation causes strokes. However, a Chiropractor can help reduce some of the risk factors associated with strokes. At Kimbrell Chiropractic, we do Nutritional Consulting that can help patients lose weight. A chiropractor is also trained to monitor high blood pressure and refer out to another healthcare provider for further treatment if necessary. If you have further questions regarding strokes or anything else, please call our office at (251) 621-3426. You can also visit What Makes Us Different to understand more about our office.
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