​​Let's talk safety. 

Chiropractic care is widely regarded as a safe and effective treatment for musculoskeletal conditions, including those affecting the spine and pelvis. When administered by qualified professionals, it offers a non-invasive and drug-free approach to managing discomfort during pregnancy and beyond.

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Let's talk about cervical manipulation.

​An unbiased look at the literature suggests cervical manipulation is safer than headlines suggest. Any treatment could cause harm if applied incorrectly. It is the responsibility of the Chiropractor to determine if their candidate is a suitable candidate for the proposed treatment. There are certain populations at risk and those who have absolute contraindications to it's use.  We are very aware of these risk factors and are conservative with its use. 

Chiropractic is not a 'one size fits all' approach. Techniques are chosen, graded and allocated according to the tissue integrity of the patient. Vascular integrity, joint stability and hypermobility are considered when discussing treatment options with our clients. 

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​Let's talk about vertebral artery dissection.

The possibility of vertebral artery dissection following neck manipulation has been a persistent concern over many years. The risk for stroke following neck trauma/manipulation appears to be dependent on the manipulation technique and the rotational forces applied to the neck. There are many different techniques of Chiropractic manipulation. In comparison to some other Chiropractic Techniques, The Gonstead and Webster Technique employed in our practice uses comparatively minimal rotational forces. 

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However, the problem of association versus causation appears to be very real. The literature documents many known dissection triggers, including hair-washing at a beauty parlour, yoga, painting a ceiling, sneezing and reversing a car. Each of these events has been linked to vertebral artery dissection - but only in an individual already predisposed. There is no suggestion that hair-washing is independently dangerous. 

The literature has highlighted many risk factors for vascular fragility, including Ehler's-Danlos syndrome, Marfan's syndrome, fibromuscular hyperplasia, hyperhomocysteinaemia, oral contraceptive use, and even migraine. Affected individuals can initiate a vertebral artery dissection through innocuous daily activities. Unfortunately, such dissection typically produces neck pain and sub-occipital headache prior to stroke, driving the sufferer to seek out help and thus drawing chiropractors, osteopaths, physiotherapists or even massage therapists into the pool of known possible triggers. The most convincing evidence now suggests that the primary role of the chiropractor in such situations is one of concerned bystander, not as a causal agent. Of course, it is possible that an over-zealous chiropractor may aggravate an underlying lesion, or fail to make the diagnosis when such patients present. But this is a far cry from the persistent theory that neck manipulation is capable of producing a dissection in an otherwise healthy individual. 

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References:

Cassidy, J. D., Boyle, E., Côté, P., He, Y., Hogg-Johnson, S., Silver, F. L., & Bondy, S. J. (2008). Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine, 33(4 Suppl), S176–S183

Church, E. W., Sieg, E. P., Zalatimo, O., Hussain, N. S., Glantz, M., Harbaugh, R. E., & Cheng, J. S. (2016). Systematic review and meta-analysis of chiropractic care and cervical artery dissection: no evidence for causation. Cureus, 8(2), e498.

Debette, S., & Leys, D. (2009). Cervical-artery dissections: predisposing factors, diagnosis, and outcome. The Lancet Neurology, 8(7), 668–678.

Jones J, Jones C, Nugent K. Vertebral artery dissection after a chiropractic neck manipulation. Proc (Bayl Univ Med Cent). 2015 Jan;28(1):88-90. doi: 10.1080/08998280.2015.11929202. PMID: 25552813; PMCID: PMC4264725.​

Paige, N. M., Miake-Lye, I. M., Booth, M. S., Beroes, J. M., Mardian, A. S., Dougherty, P., ... & Shekelle, P. G. (2017). Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis. JAMA, 317(14), 1451–1460.

Rubinstein, S. M., Peerdeman, S. M., van Tulder, M. W., & Riphagen, I. I. (2005). A systematic review of the risk factors for cervical artery dissection. Stroke, 36(7), 1575–1580.

Rubinstein, S. M., Terwee, C. B., Assendelft, W. J., de Boer, M. R., & van Tulder, M. W. (2012). Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews, (9), CD008880.

​Schievink, W. I. (2001). Spontaneous dissection of the carotid and vertebral arteries. New England Journal of Medicine, 344(12), 898–906.

Walker, B. F., Stomski, N. J., Hebert, J. J., & French, S. D. (2013). A survey of Australian chiropractors' attitudes and beliefs about evidence-based practice and clinical practice guidelines.