Over the last few years, a number of case reports have been published in the medical literature talking about the dangers of chiropractic. Many of these “studies” actually don’t involve chiropractors at all, but people performing manipulation illegally.

Now, a new article¹ from the BackLetter sets the record straight.

Really, the title of the article says it best:

“Chiropractic Care Does Not Appear to Raise the Risk of Stroke — Any More Than a Visit to a Primary Care Physician”

The article references three recent studies, all published in the peer reviewed medical literature, all of which refute the concept that chiropractic increases the risk of stroke.

One of these studies, published in Spine in January of 2008, looked at the rate of stroke in chiropractic patients:

The second study found an elevated risk of stroke among individuals under the age of 45 who received chiropractic care. However, it found the same excess risk among individuals in this age group who visited a primary care physician.

“The increased risks of vertebrobasilar stroke associated with chiropractic and primary care physician visits is likely due to patients with headache and neck pain from vertebrobasilar artery dissection seeking care before their stroke.”

So, the problem seems to be this: patients have the beginning stages of vertebral artery dissection, which present as headache and neck pain. They see a doctor — whether a chiropractor or MD — for their symptoms.

The authors of the Spine study² analyzed the health records of every citizen of Ontario for a period of nine years. The authors found 818 vertebrobasilar artery strokes in this study population.

Of these stroke patients, 40% had visited a chiropractor within 30 days of the stroke; 53% had visited a primary care physician.

Cassidy et al write:

“Since it is unlikely that PCPs cause stroke while caring for these patients, we can assume that the observed association between recent PCP care and VBA stroke represents the background risk associated with patients seeking care for dissection-related symptoms leading to VBA stroke. Because the association between chiropractic visits and VBA stroke is not greater than the association between PCP visits and VBA stroke, there is no excess risk of VBA stroke from chiropractic care.”

1. Chiropractic Care Does Not Appear to Raise the Risk of Stroke — Any More Than a Visit to a Primary Care Physician, BackLetter, 2008;23(3):28-29.
2. Cassidy JD, Boyle, E, Cote P, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine 2008;33(45):S176-S183.

A recent article in Lippincott’s Bone and Joint Newsletter published an article on the effectiveness of chiropractic for acute back pain. The article discusses the work of Dr. Paul Bishop, DC, PhD, MD, a professor of orthopedics at the University of British Columbia.

The work presented by Dr. Bishop at the International Society for the Study of the Lumbar Spine in Hong Kong states:

“This is the first randomized controlled trial demonstrating that full clinical practice guidelines care including chiropractic spinal manipulative therapy produces more favorable patient outcomes than family physician-directed care in acute low back pain patients.”

Bishop and his colleagues studied 88 patients with acute back pain. The patients were assigned to either a “guidelines-based” chiropractic group or a “usual care” group by family physicians.

“The guidelines-based care included reassurance, avoidance of passive treatments, acetaminophen for pain control, four weeks of twice-weekly spinal manipulation, and return-to-work within eight weeks.”

The outcome measure used was the Roland Morris Questionnaire, and the authors found that the chiropractic patients experienced a significantly greater improvement (2.52 points on the Roland Morris) compared to the “usual care” group (.25 on the Roland Morris).

The authors reported that “usual care” treatment offered by most primary care physicians was not based on the science of back pain (it was, in Bishop’s words, “highly guideline-discordant).

“Typically, the family physician-based care involved excessive use of passive therapies such as massage and passive physical therapy, excessive bed rest, and excessive use of narcotic analgesics, Bishop added.”

The purpose of this blog is to educate people about the science of chiropractic.

Chiropractic has been helping people with their health for over 120 years, but many people still don’t know what chiropractic is. In fact, only 8% of people in the US have seen a chiropractor.

It’s time to educate people about the benefits of chiropractic, and I think that discussing the science behind what chiropractors do is a great way to spread the word.

In this blog, I’m going to review current medical studies on chiropractic and give a short synopsis of the findings of these studies. If you’re aware of a study that would be informative, please feel free to let me know about it.