Another young person dies following chiropractic neck manipulation

Another young person dies following chiropractic neck manipulation

There is an association between neck manipulation and cervical artery dissection. Chiropractors and their professional organizations continue to deny it, but, so far, no one outside the chiropractic fraternity believes them. Their supposedly convincing studies convince only themselves.

Responsible medical organizations have, in fact, reached quite the opposite conclusion.The American Heart Association and the American Stroke Association issued a statement, accompanied by a review of the evidence: 

"Although the incidence of CD in CMT patients is probably low, and causality difficult to prove, practitioners should both strongly consider the possibility of CD and inform patients of the statistical association between CD and CMT, prior to performing manipulation of the cervical spine."

There is a growing body of case reports discussing patients who presented with CAD following cervical manipulation. As Steve Novella, MD, said in an SBM post discussing the American Heart Association/American Stroke Association statement:

"Case reports are perhaps the weakest form of medical evidence. They are essentially well-documented anecdotes. . . Dramatic case reports, however, with objective outcomes, like death, can be very useful by themselves in pointing out a potential risk that should be avoided. For example, case reports of objective and severe adverse outcomes are often used as sufficient evidence for pulling approved drugs off the market, or at least adding black box warnings."

Tragically, another "case report of objective and severe adverse outcomes" just appeared. And, also tragically, because chiropractors deny the association between neck manipulation and stroke, there won't be any equivalent of pulling drugs off the shelves or a black box warning.

Model Katie May stumbled during a photo shoot.  She told friends she had a pinched nerve and had gone to a chiropractor for neck "adjustments."  A few days after the second "adjustment," she suffered a massive stroke and died three days later.She was 34 years old and leaves behind a seven-year-old daughter.

There are several reasons why this didn't have to happen. First, chiropractic "adjustments" are a means of treating the chiropractic "subluxation," a nebulous creation only chiropractors believe in. They hold fast to the notion that spinal vertebrae can become "misaligned" and that "adjustments" are the remedy.  It is impossible that May's chiropractor needed to "adjust" some putative "subluxation" because there is no evidence the "subluxation" exists.

In keeping with their ambiguous and confusing terminology, chiropractors use the term "adjustment" as a synonym for spinal manipulation, a manual therapy used by other health care professionals, such as physical therapists, with some evidence of efficacy for low back pain. But even if what the chiropractor thought he was doing was spinal manipulation for pain (sans "subluxation"), it would not have been an appropriate therapy because there is no good evidence that spinal manipulation is effective for traumatic neck injury. As systematic review of the evidence concluded:

"Done alone, manipulation and/or mobilization were not beneficial; when compared to one another, neither was superior."

Finally, traumatic neck injury can itself cause cervical artery dissection leading to stroke. In fact, this is one of the chiropractic profession's excuses for rejecting neck manipulation as a risk factor for dissection. They say that patients who come in with neck pain were suffering from an existing dissection, which causes the stroke, and that the neck manipulation has nothing to do with it. If you believe that, why manipulate the neck of someone who has neck injury due to trauma?

Katie May was a young, beautiful Playboy model, which means her death will attract some press notice.  The New York Daily News story on her death cited the American Heart Association/American Stroke Association statement.  Apparently, the chiropractors weren't able to learn of the story in time to get their PR machine in gear to counteract any adverse publicity. No doubt they are playing catch up now. 

Note: For a more thorough analysis of May's death and chiropractic cervical manipulation, see Did chiropractic manipulation of her neck cause Katie May's stroke? on Respectful Insolence.  

Points of Interest 02/08/2016
Points of Interest 02/02/2016

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