[Chiropractic case study] The risk of stroke with spinal manipulation

There’s no question that Baby Boomers (those born between 1946 and 1964) have defined the culture of the United States in everything from fashion, to music, to education.

Even now, Baby Boomers have left their unique mark on the state of health care in America, based on their sheer numbers. According to the Pew Research Center, there were slightly more than 74 million Baby Boomers in the United States last year, accounting for almost 23 percent of the population.¹

If we add in Generation X (those born between 1965 and 1983), that’s another 77 million people who are also getting up there in years.² This makes a grand total of 151 million older Americans who are either already experiencing common health issues associated with aging, or will be doing so in the next five to 10 years.

You have no doubt already seen a certain portion of older adults in your practice. In fact, a 2012 study published in Chiropractic & Manual Therapies estimated that about 14 percent of patients over the age of 65 seek out chiropractic care.³ While these older patients’ chief complaint was back pain, neck pain was also often mentioned as a reason for a first visit to a chiropractor.

However, a first visit to a chiropractor can full of trepidations for older patients. Many of them have exhausted all other avenues to get relief from their pain. They’ve likely gone through any number of standard treatments, over the counter and prescription medications, and may have even undergone surgery – all to no avail.

On top of that, their friends and family may pass along false information that they have read online or seen on television about the dangers of chiropractic care, specifically for the elderly. The most common of these myths is that chiropractic adjustments to the cervical spine can lead to a vertebrobasilar stroke (VBS).

Research results

In fact, a recent study that examined data regarding a large group of elderly chiropractic patients with neck pain found that the risk of VBS as a result of cervical adjustment was very low.⁴

There have been small studies to determine the level of risk for stroke following a cervical spinal adjustment. Because these are too small to see any definitive pattern as to the risk level, a 2012 meta-analysis in the International Journal of Clinical Practice pooled data from five smaller studies examining any connection between cervical manipulation and stroke.⁵

The authors concluded that there did not seem to be a strong association between the two, but that future, more robust research was needed.

A 2015 article published in the Journal of Manipulative and Physiological Therapeutics overcame the issue of only having a small number of patients by examining Medicare claims records of more than 1 million elderly patients between the ages of 66 and 99 who had visited either a chiropractor or their primary care provider for neck pain.⁴

The researchers noted any occurrence of stroke after the office visit and compared the risk within 30 days for those patients who saw a chiropractor versus those who saw a PCP. Regardless of which type of doctor the patients visited, the incidence of VBS was extremely low. Although the risk was lower at 7 days post-visit for those who saw a chiropractor than for those who saw a PCP, both risk values were not of any clinical significance.⁴

Your elderly patients’ first visit to see you will be understandably a bit scary for them. Now you can reduce their fear by helping dispel some of the myths about the risk of stroke associated with cervical adjustments. Your patients will be at ease, and you can help relieve their worry AND their pain.

References

1. Millennials overtake Baby Boomers as America’s largest generation. Pew Research Center. Accessed Dec. 18, 2017.
2. Generation X: America’s neglected ‘middle child.’ Pew Research Center. Accessed Dec. 18, 2017.
3. Dougherty PE, Hawk C, Weiner DK, et al. (2012). The role of chiropractic care in older adults. Chiropractic & Manual Therapies, 20, 3.
4. Whedon JM, Song Y, Mackenzie TA, et al. (2015). Risk of stroke after chiropractic spinal manipulation in Medicare B beneficiaries aged 66 to 99 years with neck pain. Journal of Manipulative and Physiological Therapeutics, 38(2), 93-101.
5. Haynes MJ, Vincent K, Fischhoff C, et al. (2012). Assessing the risk of stroke from neck manipulation: A systematic review. International Journal of Clinical Practice, 66(10), 940-947.