Getting Treatment for Your Neck

Many medical procedures carry risk.  We’ve all seen the drug commercials on TV with long, speedy disclaimers that the drug might make you wet yourself or stop your heart or something.  We do these things to ourselves because the benefits are greater than the risks involved.  For example, the risks of taking Plavix (fatigue, easy bruising) seem pretty small compared to the benefit of preventing stokes.  In medical areas, good science means taking a look at various treatments and deciding whether the benefits are greater than the risks. 

My neurologist told me some time ago that there is growing evidence that chiropractic adjustments to the neck are linked to strokes and arterial damage. A lot of medical treatments have risks, so that doesn’t bother me too much.  Because I am inclined to follow the evidence, I want to know:

1.       Is it true that neck manipulations are connected to strokes and arterial damage?

2.       If it is true, do the benefits outweigh the risks?

The British Journal of Medicine (BMJ) publish an article on June 7^th 2012 asking these very questions.  The researchers did a systematic review of this area, which means they gathered all the data points they could get, to see if any indicators could be found or conclusions drawn.

Problems

Nobody has done a randomized, double-blind study to see if people who get chiropractic neck treatment have stokes.  That would be a fast way to be charged with ethical violations.

The next problem is that when someone has a stroke, most of the time nobody is going to ask them if they have been seeing a chiropractor.  For that reason, the number of strokes related to neck manipulations is highly likely to be underreported. 

On the other hand, just because two things seem correlated, does not mean one is causing the other.  As the JREF article (below) points out, some chiropractors counter that people had arterial damage and neck pain already; that’s why they came for treatment.  That sounds like baloney to me.  If they know someone has arterial damage why in the world are they doing neck adjustments on them!?

Are Neck Manipulations Linked to Strokes and Damage?

The answer is: yep!  It turns out that jerking the neck around has been correlated with arterial damage and strokes.  According to the BMJ article, the rate of damage to the artery from these neck adjustments is between 1 in 400k to 5.8 million manipulations.  Compared to other medical treatments, this doesn’t seem like a big risk.  On the other hand, death from stroke is a pretty bad outcome if you are only seeing a chiropractor for headaches or a sore neck.  So overall, I would consider the riskiness pretty high: even though the absolute risk is low the severity is high.

Do Benefits Outweigh the Risks?

Basically, studies have shown that there is no measurable benefit to neck manipulation (PubMed 1-4).  Other studies have shown that getting your neck cracked by a chiro was no better than applying tape to the neck (PubMed 5 below).  I should point out that there was no placebo in that study, so just remember that they were comparing two treatments – they weren’t actually testing if the treatments work.  Neck adjustments work as much as tape.  And what is the downside to taping your neck?  None.  Well, maybe some skin irritation.

 There Are Other Risks

According to the Guardian, not very long ago, 1 in 4 chiropractors in Britain were under investigation for making false claims of chiropractic services helping various conditions (like bed wetting!).  The British Chiropractic Association has fired back with an exhaustive (chuckle) list of studies supporting chiro.  There were 29 studies on the list.  10 of them had nothing to do with chiropractic and some of them weren’t actually studies at all.  The list also ignored large, high quality studies that showed no benefit to chiropractic treatment.  The bottom line is that your chiropractor may actually be making false claims about what symptoms they can help with.  So you should be careful.

 What’s the point?

The benefits of getting your neck adjusted (same benefit as taping) are MUCH smaller than the risk of injury or death.  For this reason, the British Medical Journal recommends we abandon chiropractic neck adjustments for safer and more beneficial treatments.  No matter how persuasive your chiropractor or neighbors may be, a scientific review of the evidence says that the benefits of neck adjustments do not outweigh the risks.

 Scientific support for chiropractic treatments as a whole is iffy.  In fact, even the concepts behind chiropractic are fairly iffy.  Overtime, scientific evidence will continue to collect, but for now the best we can do is follow the evidence.

British Journal of Medicine

James Randi Education Foundation

Science based medicine

The Guardian

Pub Med Study on chiro effectiveness 1

Pub Med Study on chiro effectiveness 2

Pub Med Study on chiro effectiveness 3

Pub Med Study on chiro effectiveness 4

Pub Med Study on chiro effectiveness 5