Safety
Canadian Medical Association Journal

Canadian Medical Association Journal (CMAJ), puts the risk of stroke following neck adjustment at 1 in every 5.85 million adjustments.

In fact, the incidence of stroke associated with neck adjustments is so rare, that it was not possible for the researchers to establish a meaningful rate of occurrence despite the high number of cervical adjustments that are performed.

It is estimated, that over a 10 year period, Chiropractors in Canda perform over 134.5 million neck adjustments. During the same 10 year period, only 23 reported cases of stroke could possibly be associated with the treatment. This extremely low occurrence cannot be matched by any other medical procedure.

Lets compare this to these medical statistics in the United States.

Quarter-million doctor-induced deaths annually in the U.S.

A study published in The Journal of The American Medical Association (2000:284:94) by Barbara Starfield, MD, MPH, showed that in the U.S. there are:

• 12,000 deaths/year from unnecessary surgeries.
  
• 7,000 deaths/year from medication errors in hospitals.
  
• 20,000 deaths/year from other errors in hospitals.
  
• 80,000 deaths/year from nosocomial infections in hospitals (infections occurring due to hospitalization and exposure to diseases in the hospital).
  
• 106,000 deaths/year caused by the adverse effects of prescribed medications.

Chiropractic Neck Manipulation Facts

Chiropractic care is widely recognized as one of the safest, drug-free, surgery-free therapies available for the treatment of back and neck pain, headaches and other musculo-skeletal conditions. Few other therapies can demonstrate a better safety record for the treatment of spinal pain syndromes. Of course, no health treatment is completely free of potential adverse effects. Even common over-the-counter medicines carry a risk. Fortunately, the vast majority of adverse effects associated with spinal adjustments are typically minor and short lived.

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QUESTIONS AND ANSWERS

How safe is a neck adjustment?

There is a rare risk of stroke or stroke-like symptoms associated with adjustment of the neck. The most recent research published in 2001 in the Canadian Medical Association Journal puts the risk at one in 5.85 million adjustments.(1) Reports on the subject over the past 40 years present a range of estimates based on the different research methodologies. However, all of the published studies to date agree that the risk is extremely low. Overall, a ratio of one to two cases per million neck adjustments represents a conservative and generally recognized estimate.(2) That is less than your risk of getting struck by lightning or of dying while skiing or playing soccer.(3) Most chiropractors do not have a single case of a patient experiencing serious adverse effects during their entire professional lives.

How does that compare to other risk factors?

There are many risk factors for stroke including blood clotting problems, hypertension, smoking, high cholesterol, use of birth control pills, heart problems and trauma such as sport injuries or blows to the head from an accident. All carry a greater degree of risk than spinal adjustment. Strokes or stroke-like symptoms are also associated with many normal everyday activities such as cradling a phone between your ear and shoulder during a prolonged conversation, having your hair washed at a beauty parlor, dental procedures, painting a ceiling, and turning your head while driving. Strokes also occur spontaneously in some people for no apparent reason.

What are the risks for other therapies?

Spinal adjustment is significantly safer than other common therapies for back and neck pain and headache. Long-term use of non-steroidal anti-inflammatory drugs for pain cause 1,000 serious complications and 100-200 deaths per million cases. Surgeries for neck and back pain cause 15,600 cases (4) of paralysis or stroke per million cases, and 6,900 deaths per million. (5)

Is neck adjustment a forceful action?

No, it is not. Neck adjustment is done within the normal range of motion. This normal range is less than what is required to turn your head when backing up a car. Adjustment of a joint is a highly skilled procedure which requires relatively little pressure. This has been clearly demonstrated in studies to determine the degree of physical stress applied during adjustment. It is skill, not strength, that is needed to conduct a safe, effective adjustment. Chiropractic education is Canada is an intensive four year program following three years of university undergraduate studies. By the time they graduate, Canadian Chiropractors are among the most skilled in the world.

Why has there been media attention focused on neck adjustments?

Attention has been recently directed to neck adjustment by a group of neurologists called the Canadian Stroke Consortium. The Consortium has, on a number of occasions publicized alarmist data from an incomplete survey based on a questionnaire. The Consortium has never revealed what method it is using for confirming whether the cases of stroke it reports are in fact associated with neck adjustment. Until such time as the survey is published in a peer-reviewed medical journal where the survey design and conclusion can be evaluated by medical peers, their reviews and comments should be viewed with skepticism and caution.

Does the medical profession regard neck adjustments as safe and appropriate treatment?

Yes, Most chiropractors have excellent relationships with physicians and cross refer patients on a routine bases. Depending on a patient's problems, their care may be co-managed by both a doctor of chiropractic and a medical doctor. Further evidence of the respect which chiropractic has within the medical community was the presence of Canadian Chiropractors on the heath care team for Canada's athletes at the 2002 Winter Olympics, as well as previous Olympics and Pan Am games.

For further information on the Chiropractic profession and Chiropractic care visit the Canadian Chiropractic Association website at www.ccachiro.org and the College of Chiropractors of Alberta at www.ccoa.ab.ca.

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References:

1. Arterial Dissections Following Cervical Manipulation: The Chiropractic Experience, Haldeman S, Carey P, Townsend M. Papadopoulos C, Canadian Medical Association Journal Vol. 165, No 7, 905-906, 2001.
   
2. The Appropriateness of Manipulation and Mobilization of the Cervical Spine: A Systematic Review of the Literature, Hurqitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG, Spine 21(15): 1746-1760, 1996
   
3. Risk Factors and Precipitating Neck Movements Causing Vertebrobasilar Artery Dissection After Cervical Trauma and Spinal Manipulatin, Haldeman, S. Kohlbeck FJ, Mc Gregor M. Spine 24(8); 785-794, 1999
   
4. Conservative Management Of Mechanical Neck Pain: A Systematic Overview and Meta-Analysis, Aker PD, Gross AR, et al. The British Medical Journal, 313: 1291-96, 1996
   
5. The Reality and Acceptance of Risk, Dinman JD, Journal of the American Medical Association, 244(1): 1226-1228, 1980

A Risk Assessment of Cervical Manipulation v. NASIDS for the Treatment of Neck Pain, Dabbs, V, Laluretti WJ, Journal of Manipulative and Physiolocial Therapeutics 18:530-6, 1995 5 ibid

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Some Important Thoughts on Children and Chiropractic

Common Questions From Parents

• How early should children be adjusted?

• Is it safe?

• Aren't their bones still soft?

• Why do they need adjustments?

• What if they cry?

• How can we afford it?

All of these questions and more go through the minds of parents who are considering chiropractic care for their kids.  Some parents are hesitant about getting their children adjusted even though they are under care themselves.

Our kids are so special to us that sometimes, in an effort to protect them, we become overprotective and deprive them of necessary and valuable experiences.

If chiropractic care is necessary to your good health and for reaching your full potential in life as an adult, then it logically follows that it is even more necessary for a child!

After all, they have nerve systems that control and coordinate all of their body functions just as you do.  And, just like you, they can get subluxations that will interfere with the full outward expression of their Life force .

The only difference is that they still have an entire lifetime ahead of them in which to manifest the results of what they do today.

It's Never Too Soon

Subluxations can occur at any time.  The first one may very well have occurred at your baby's birth.  That is why parents who understand the importance of being subluxation-free have their newborns examined by their chiropractor as soon after birth as possible.

By correcting subluxations at an early age, the damage that inevitably comes from functioning at less than optimal levels can be prevented.  The longer a subluxation is present, the greater the damage.  In addition, the longer a subluxation is present, the longer your child's body will continue to "reproduce itself" (i.e., grow) in the wrong way!

"As the twig is bent, so grows the tree!"

Many people who come into a chiropractor's office for the first time as adults would have had far greater potential for regaining their health if they had received regular chiropractic care as children.

Kids Make Great Patients !

Adjusting a child is not a difficult procedure.  In fact, in most cases, a child's spine is much easier to adjust than an adult's.  They have not had the long-standing subluxations, their muscles are usually not as tense and they are usually more relaxed in general than adults.

Not only are kids easier to adjust, but also in most cases, they hold their adjustments for longer periods of time and their corrective adjustment plans are almost always significantly shorter than the average adult. However, with the falls, accidents and the generally active lives most kids experience, regular check-ups are vital.

It's Worth The Effort

Chiropractic adjustments are generally painless.  Children may, on the first visit or two, be somewhat reluctant.  However, they rarely hesitate to get on the table to be adjusted, especially when they see that visiting the chiropractor is a family affair .  When they see Mom, Dad and their brothers and sisters getting adjusted, they are usually more than willing to be checked for subluxations too.

We will work with you so that your children will become accustomed to their adjustments.  In fact, in a very short period of time, most kids really look forward to their regular chiropractic visits.

Thos e children that are reluctant at first should be lovingly told that they must be adjusted and why it is so important (to keep their Power on!).  As parents, we realize that our children are not going to like or enjoy everything that is good for them.  Spinach is not enjoyable for most kids, and naps aren't much fun either.

Chiropractic adjustments are vital to their good health, and the few tears that may occur on the first visit (usually because of fear of the unknown), are well worth the benefits to our precious little ones.

Obviously, children who are adjusted regularly from infancy think of their visits to the chiropractor as a regular part of their lives and are not the least bit hesitant to climb onto the adjusting table.

Chiropractic Care is Vital to Your Child's Health and Life !

Lastly, it is of great importance that parents not think of adjustments for their children as " something they might as well do since their kids have come along to the office with them anyway ."  Chiropractic care for your children is vital to their health and is an absolute necessity to their development and for actualization of their full potential in every area of life.

We have a Family Plan that makes it affordable for most families to receive the care they need.  The money saved on treatments for illness is often enough to convince most parents of the benefits of family care.  But, the peace of mind that comes from knowing that you have provided your children with the best possible chance to perform at their best is the greatest benefit of all!

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