It estimated an incidence of 1.3 cases for every 100,000 people under 45 receiving neck adjustments.

The generally accepted incidence rate for stroke following cervical manipulation(CM) is 1 in 5 million.  Some studies claim 1.5 million and others claim 12 million.  There are approximately 30 million cervical manipulations performed in the USA every year.  So, six strokes following CM can be accurately atributed to my colleagues each and every year.

These studies that show the insane rate quoted from the article always have one thing in common.  When you examine each incident it is found that the vast majority of stroke following CM occurs after being performed by non-chiropractic practitioners.  Massage therapists and physical therapists who overstep their training and decide to perform CM on their patients are who are generally causing these problems.  In several instances an osteopath is responsible. 

The last study I saw involved a review of approximately 14 cases.  It was found that chiropractors were involved in only two or three.  The rest were the practitioners I mentioned above.

Their hypothesis was that a chiropractic technique called cervical spinal manipulation, involving a forceful twisting of the neck, could damage two major arteries that lead through the neck to the back of the brain.

No bias in this journalism. 

I was in my first adjusting class in 1997.  The curriculum had been steadily moving away from rotational adjusting and into a lateral flexion(side bending) maneuver with no or slight "pre-loaded" rotation for years before hand.  Studies showed that the rotational component of the adjustment from a "standing start" were indeed problematic.  Me and my classmates were healthily warned off rotational adjusting and taught to "pre-load" any rotation necessary.

Before their strokes, younger patients who saw chiropractors were more likely to have complained beforehand of head and neck pain — symptoms often preceding a stroke — suggesting they had undiagnosed dissections and had sought out chiropractors for relief, not realizing a stroke was imminent.

This is the crux of the problem and I have no problem jumping in the shit of my colleagues.  My degree is a Doctor of Chiropractic.  Too many people that come out of the schools conferring said degree are quite content with being Chiropractors, or bone movers.  They fail to harness the first half of their degree and become Doctors.  They put on their spinal blinders and lack the examinational skills to ferret out a dissection and the signs leading to a stroke.

Proximity does not equate to causality.

THE BOTTOM LINE

Forceful neck manipulation seems to carry a small risk of arterial tears.

Which is why you need to go to someone else if the idiot is cranking your neck around like he/she is playing Frolf.

The true bottom line is this:

My malpractice premium is less than $1000 a year.  Your general practicioner can have premiums that are $1000 a month.  If you know anything about risk ratios then the insurance industry doesn't seem to bear out that chiropractors are killing folk left and right.  If the risk was there the premiums would be worse.  It just isn't so.

But I appreciate the mental muscle flex this AM, I've been staying up too long here lately.

Interesting to get some  knowledgeable context.

There are some risks like this that that can be better managed and some that are just part of being a human with some fraility. My girlfriend has trained doctors to deliver at risk pregnancies. She has faced carreer ending reviews from the inevitable hopeless cases that go badly. The insurance rates for such work are crushing.

GooberMcNutly wrote:

The insurance premiums are lower because you aren't performing actual medicine.

Until he relieves your insufferable pain without prescription. Fuck MDs with a pointy stick.

Banjo wrote:

Scotty. What is the risk of missing a metastatic lesion on standard x-ray and going forward with spinal manipulation? I would think that these patients would be a huge risk for spinal fracture or paralysis. Do you now require MRI or CT before aggressive therapy?

Well you mentioned the obvious risk, fracture. 

Paralysis would be very difficult to achieve since the majority of METS occurs in the dorsal and/or lumbar spine and lends itself to being part of a larger group of musculature to absorb even the most egregious amount of force.

I have actually shied away from plain films in the past year or two as they tend to offer very little information that wouldn't be better suited coming directly from an MRI.  I'm not shooting films just to pad the bottom line like every other doc in town.

If I do take a film it is in response to the exam and will be warranted and reviewed.  If I don't like what I see I have my local imaging facility re-read it and then follow their MRI/CT recommendations.

90% of all chiropractors are quacks or bullshit artists who do nothing for you but make you feel better for maybe 20 minutes tops (and establish a lifetime relationship with you taking your money each week for those magical 20 minutes). 

Lay face down on a table or mat with moist hot compresses on your back for a half hour and then get up and stretch.  If you feel the need to hear things go "pop" then stretch, twist, etc. until you hear the sound (that doesn't have any therapeutic value other than the reassurance the sound brings).  You'll have that same magical feeling free for the same 20 minutes.

(no, I don't have any statistics to back up the above.  This is High-Street, no the New England Journal of Pseudo-Medicine.)

Last edited by Zookeeper (2008-08-27 15:20:17)

Scotty wrote:

Zookeeper wrote:

90% of all chiropractors are quacks or bullshit artists who do nothing for you but make you feel better for maybe 20 minutes tops (and establish a lifetime relationship with you taking your money each week for those magical 20 minutes). 

Lay face down on a table or mat with moist hot compresses on your back for a half hour and then get up and stretch.  If you feel the need to hear things go "pop" then stretch, twist, etc. until you hear the sound (that doesn't have any therapeutic value other than the reassurance the sound brings).  You'll have that same magical feeling free for the same 20 minutes.

(no, I don't have any statistics to back up the above.  This is High-Street, no the New England Journal of Pseudo-Medicine.)

I'm assuming since you love me Zookie that I fall in that 10%.

I have no idea where you fall in.  Buy you have my (not gay) love all the same Scotty.

I have a theory though know of no research to bear it out:  I suspect that someone who keeps seeing a chiropractor for years on end (with no end in site) is more likely than not to be the same type of person who sees a psychologist for years on end (with no end in site).  They are both great gigs for setting up profitable lifetime relationships (dependencies) with people (marks).

Scotty wrote:

Zookeeper wrote:

I have a theory though know of no research to bear it out:  I suspect that someone who keeps seeing a chiropractor for years on end (with no end in site) is more likely than not to be the same type of person who sees a psychologist for years on end (with no end in site).  They are both great gigs for setting up profitable lifetime relationships (dependencies) with people (marks).

I think you, like most people, misunderstand the nature of care.  I do not advocate once a week or even once a month care for my patients.  Personally I happen think I'm a little better than that and can adjust you so that things last a bit longer.

That being said it is rather difficult to get the Average American past an 8 week time frame.  Sedentary lifestyles along with poor lifestyle choices do not lend themselves to proper musculoskeletal health.

Many of my colleagues do over treat.  You can bet your bottom dollar that the quantity of treatments they prescribe is inversely proportional to the quality you will receive.

So does this mean you do full release with your massages, or what?

Scotty wrote:

I think you, like most people, misunderstand the nature of care.  I do not advocate once a week or even once a month care for my patients.  Personally I happen think I'm a little better than that and can adjust you so that things last a bit longer.

I only know from my own past experience and what I've observed in others.  The first chiropractor I ever went to (back in high school) was a quack.  We listened to what he had to say, laid face down on a table as he demonstrated a bullshit move to try to convince me that one leg was longer than the other (did the same for my mother since she was there too) and said if he treated me he'd take me off of all dairy (to free me from the evil hold of Lactic Acid).  I don't know if we paid for the consult but we never went back.

Over the years I went to a couple different chiropractors when I had bad back episodes.  I would always feel better for about an hour after the "adjustment".  Then everything would magically pull right back into the same position.  It reminds me of the magic that lets me crack my knuckles every hour on the hour - and has no actual beneficial aspect.  Anyway, I finally realized it was laying on my stomach for 20 minutes with warm moist compresses on my back that was making me feel better.  I also noticed that after a few weeks of treatment I was better.  On a hunch I stopped going to chiropractors when I had back problems and (believe it or not) I usually got better after the same amount of time.

About 10 years ago I read a book by Dr. John Sarno, bought into his theory and have had only two episodes of real back problems since.  The longest it took me to get over one was a week.

That being said it is rather difficult to get the Average American past an 8 week time frame.  Sedentary lifestyles along with poor lifestyle choices do not lend themselves to proper musculoskeletal health.

I've met several people who see their chiro religionsly or at least have a two month engagement with them once or twice a year.  No doubt there are people who really need that much intense care.  But all a lot of them do is:
1) give them a sheet of paper with stretching exercises on it,
2) get 'em relaxed with hot compresses and
3) press on them and twist them to produce popping noises convincing them that bones were actually repositioned in some way that spasming muscles won't pull them back out of within an hour.
Those guys are just snake oil salesmen (whether they are aware of it or not).

ptah13 wrote:

Scotty wrote:

ah297900 wrote:

So does this mean you do full release with your massages, or what?

Not for punk ass posters who reek of trepidation in the vast majority of their posts.

Is he asking you if your treatment comes with "happy ending"?

Yes, and since I jumped in his shit in his relationship thread I inferred a playful, "Hey, I know you have grilling me like the noob that I am, but see I can joke with you and we can be friends" vibe so I called him out on that.

Banjo wrote:

I believe one day some form of subconscious therapy will be the standard of care for most m-s issues

While I won't discount the efficacy of hypnotherapy and other non-mainstream medical practices (acupuncture, herbs, other naturopathic remedies that have demonstrated reproducible effects, etc.), it would be unwise to implant longterm suggestions about the sensation of pain. Pain exists to tell us that there's something wrong, and that it should be attended to with all due haste. Chronic pain sufferers are not different enough from those who experience it intermittently, or temporarily; i.e, it would not be good to "turn off" the perception of pain for an indeterminate period because, obviously, more harm could come to that individual, or the reason for their pain could worsen. If used in this manner, it should only be a treatment of last resort.

Hypnosis is not quite the panacea its practitioners and patients make it out to be.

Scotty wrote:

ptah13 wrote:

Scotty wrote:

Not for punk ass posters who reek of trepidation in the vast majority of their posts.

Is he asking you if your treatment comes with "happy ending"?

Yes, and since I jumped in his shit in his relationship thread I inferred a playful, "Hey, I know you have grilling me like the noob that I am, but see I can joke with you and we can be friends" vibe so I called him out on that.

Well, I went to a chiro once and have since been to a  physical therapist and received the exact same treatment... so I guess that makes the physical therapy voodoo bullcrap, too?


I feel so violated. I didn't even get a hand job.

Zookeeper wrote:

If you feel the need to hear things go "pop"

Someone has to do it:



make the noise..make the noise....I LIVE FOR THE NOISE!!!