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Risk of stroke from chiropractor neck adjustment remains fierce debate

by Jaclyn Cosgrove Published: December 10, 2012

/articleid/3736001/1/pictures/1903058">Photo - Elizabeth Caplan, who suffered a stroke while being treated by a chiropractor, uses her hands to show how she says her neck was injured during the treatment. PHOTOS BY JIM BECKEL, THE OKLAHOMAN
Elizabeth Caplan, who suffered a stroke while being treated by a chiropractor, uses her hands to show how she says her neck was injured during the treatment. PHOTOS BY JIM BECKEL, THE OKLAHOMAN

Over the past 30 years, Cloutet has learned that, just like with anything, the quality of care sometimes depends on the chiropractor.

“There are good ones, and there are bad ones,” Cloutet said. “Once you find a good one, which I feel I have, it's very beneficial.”

Some estimates show that between 5 and 10 percent of a primary care physician's patient load relates to musculoskeletal conditions that would be treatable through chiropractic care, said chiropractor and professor Stephen M. Perle.

Perle said more hospitals and community health organizations are beginning to hire chiropractors.

Perle, a clinical science professor at the University of Bridgeport in Connecticut, said although the anecdotes of stroke are compelling and it's horrible for that person, health care must be based on evidence-based practices.

“It is possible that manipulation does cause strokes, but we just don't have that evidence,” Perle said. “All the biomechanics research says that the amount of force that's applied to the vertebral arteries, which is supposedly the problem, is much less during manipulation than what happens to people in day-to-day living. Drive a car, back your car up, don't use your rearview mirror, turn your neck around to go look out the back window, and you've created more force on the artery than a chiropractor will.”

Perle said if he had unlimited resources and grant money to end this debate, he would gather 20 million people for a randomized clinical trial, the “gold standard” in research, on the likelihood of stroke under chiropractic care.

“I would put 10 million of them into a group that got cervical manipulation, and I would put 10 million of them into a group that got a sham procedure that looks like cervical manipulation but isn't, and then I'd look and see whether they had strokes,” Perle said.

“Now the question is, is the problem so great we would expend the kind of resources to put 20 million people into a research study?”

‘Starting over'

Before the accident, Caplan, an Oklahoma City resident, had taught special education courses and courses for people who are blind. She had served as a linguist in the Army and knew several languages, including Somali, Hebrew, Arabic, Russian, Spanish and sign language.

She remains blind in her right eye and has trouble recalling what she learned earning her master's degree.

“At 44, everything that I worked for and earned is now gone, and I'm essentially starting over,” Caplan said.

Caplan does not blame a specific chiropractor for what happened but rather the practice of spinal manipulation for neck pain.

“The problem doesn't lie with the actual practitioner,” Caplan said. “The risk of stroke, a vertebral dissection, is intrinsic to the procedure. It's not that one person in the hands of one who's more skillful can avoid causing it.”

Tim Young, the Oklahoma Chiropractors' Association president, has been a chiropractor for 18 years and said he has not had a patient ever experience stroke.

One of the symptoms of stroke is sudden severe headache with no known cause, according to the National Institute of Neurological Disorders and Stroke.

Young said people who have strokes after getting their neck adjusted could have been in the early signs of stroke when they were adjusted.

If a person goes to a medical doctor for a migraine, gets medication and later has a stroke, no one blames the medical doctor, Young said.

“If they go to their chiropractor with neck pain or headache, and the chiropractor sees them and adjusts them, and they leave and have a stroke, ‘It must have been the chiropractor,'” he said.

by Jaclyn Cosgrove
Medical and Health Reporter
Jaclyn Cosgrove writes about health, public policy and medicine in Oklahoma, among other topics. She is an Oklahoma State University graduate. Jaclyn grew up in the southeast region of the state and enjoys writing about rural Oklahoma. She is...
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