In reply to a concerned reader

One of our readers, who happens to be a physician, brought up a valid concern about the risk of stroke in children following chiropractic manipulation of the cervical spine. So I asked myself the question: what is the true risk of stroke following manipulation of the cervical spine?

Well, the existing data in the literature does not give a definitive answer. The evidence to date indicates that the risk associated with chiropractic manipulation of the neck is both small and inaccurately estimated. The studies consist mainly of surveys and case series, and the reported risk ranges from 1 to 3 cases per million. Better designed studies are needed to answer this question more accurately. But however small, the risk is real and should be discussed with patients, especially those under 45yrs. of age.

I must admit that I've always been a little wary of cervical spine manipulation.
I have learned however that there is a difference between specific chiropractic spinal adjustment and cervical manipulation. The latter is a less precise and more forceful passive movement of the joint which probably carries a greater risk. Chiropractors are highly trained to perform specific adjustments. Apparently many of the reported cases included cervical manipulations performed by non-chiropractic practitioners including MDs, osteopaths, physiotherapists and masseurs.

That said, my understanding is that the "manipulation " done on babies and children is very different and consists mainly of gentle massage. I would NOT recommend anything more forceful for children. Our expert, Chiro Paul, might address this issue more specifically.
It is devastating to hear such horrific stories especially when they involve children. To our reader, who has had the misfortune of seeing two children suffer strokes after cervical manipulation, I would say: even one such case is too many and unacceptable...I would be very interested to hear more about the circumstances surrounding these cases...

As physicians, I think we need to keep an open mind and realize that a large percentage of our patients do consult alternative health care professionals, whether they admit it to us or not. If we adopt a non-judgemental approach, we might learn more about our patients...we could then offer better care by informing them of the possible risks vs benefits, and even help them find properly trained practitioners. Ultimately it would be up to the patient to make an informed decision and choose the preferred treatment options.


Doc Taline