Every year, large numbers of people in the U.S. see chiropractors for relief of headaches; back, shoulder, foot and neck pain; and for help with numbness and tingling or a loss of strength in the arms and hands.
About 35 million adults nationwide saw a chiropractor in the previous 12 months, according to a survey done by the Gallup Panel that was released in August. The survey, conducted on behalf of the Palmer College of Chiropractic, based in Davenport, Iowa, found that more than 62 million people have seen a chiropractor since 2011, and 77 percent of those treated found their chiropractic care “very effective.” And indeed, chiropractors tout their treatment as the least invasive and safest therapy for many ailments. But chiropractic treatment is not without risk, as a recent high-profile death shows.
The Los Angeles County Coroner’s office ruled in October that the mysterious death of Playboy model Katie May was attributable to a stroke caused by an artery that was ruptured during a chiropractic treatment, specifically, a neck manipulation. May, 34, died in February after she went to a chiropractor for treatment following a fall.
Here’s a closer look at some of the advantages of chiropractic treatment, what some doctors say are potential downsides and suggestions for how to obtain the best care.
What They Do
Chiropractors treat people by aligning their spine with a variety of manipulations. During the first visit, chiropractors typically perform a physical exam and take a health history, paying special attention to the spine and whether the patient has normal bone density. People with lower levels of bone density, such as people with osteoporosis, would receive gentler treatments. The chiropractor typically uses his or her hands to apply controlled, rapid force to a damaged or injured joint, to allow the joint to move in a normal manner and reduce pain and inflammation, says Ray Tuck, a chiropractor in Blacksburg, Virginia, and the chairman of the board of the American Chiropractic Association. One maneuver is the high-velocity cervical adjustment, in which the patient relaxes his or her head in the hands of the chiropractor, who quickly thrusts the head in one direction — sometimes creating a cracking sound. Chiropractors can also conduct gentler, low-velocity cervical adjustments.
Carly Soda, 33, a physician’s assistant who lives in a Philadelphia suburb, is a big fan of the high-velocity cervical manipulation. Five years ago, Soda went to a chiropractor when she thought she was suffering from carpal tunnel syndrome. By then, a variety of medical treatments had failed. The chiropractor analyzed her problem as stemming from a pinched nerve in her neck and conducted a high-velocity neck manipulation. After the treatment, “my hands were better in a week, 100 percent,” Soda says.
Chiropractors also treat some patients for headaches that are caused by nerve irritation that refers pain to the head, Tuck says. Treatment can alleviate these headaches by reducing nerve irritation.
Benefits
Some studies have shown chiropractic care to be beneficial. In a study published in Spine Journal in 2008, researchers evaluated the chiropractic treatment experiences of 192 people with back-related pain or sciatica, a condition in which a pinched nerve in the lower spine causes leg pain. The study care was rated worthwhile by 87 percent of the participants. Another study published in the British Medical Journal in 2003 evaluated 183 patients with neck pain who were randomly assigned to receive treatment that involved spinal manipulations, physiotherapy (mainly exercise) and care from a general practitioner, which involved primarily counseling, education and prescription drugs. The people in the study kept cost diaries for one year. The study found that manual therapy was more effective and less costly than physiotherapy or care by a general practitioner.
The American Chiropractic Association says neck manipulation procedures are quite safe. Todd Sinett, a chiropractor in New York City and author of the book “3 Weeks To A Better Back,” says he has conducted cervical manipulations for 20 years without adverse effects to his patients.
“I’m not saying that cervical adjustment is not without risks,” Sinett says. “But if you are comparing the risks to those of negative drug interactions, such as allergies, and the risks of surgery, chiropractic is safer.” Sinett pointed to a 1996 study by the Rand Corporation, a nonprofit research group based in Santa Monica, California, that found the risk of an adverse effect from a cervical manipulation at less than one per 1 million treatments. A 2001 study published in the Canadian Medical Association Journal found the risk of a stroke following a cervical chiropractic treatment to be one per 5.85 million treatments.
[See: 11 Ways to Cope With Back Pain.]
Risks
Nonetheless, in 2014 the American Heart Association released a scientific statement saying getting your neck adjusted by a chiropractor or osteopathic doctor may be linked to an increased risk of stroke. Even low risks are unacceptable, several physicians say, adding that they would advise patients to stay away from high-velocity neck manipulations.
Chiropractic manipulations of the thoracic and lumbar spine areas are safe, because chiropractors cannot create enough force to damage those regions, says Dr. Ramin Jahavery, a pediatric neurosurgeon with the Pediatric Surgery Center at Miller Children’s & Women’s Hospital in Long Beach, California. “The neck is different. There is not as much robust musculature there,” Jahavery says.
Even a small chance of sustaining a ruptured artery for short-term relief that may not even last a week isn’t a worthwhile risk. “In this situation, because the benefits are so limited, the risk has to be zero,” Jahavery says, adding he has treated several patients who suffered minor strokes from arteries that were ruptured during chiropractic treatments.
“The risk is low, true, but I wouldn’t recommend [neck manipulation treatment],” adds Dr. Vernon Williams, director of the Kerlan-Jobe Center for Sports Neurology and Pain Medicine in Los Angeles. “I’ve referred patients to chiropractors. I think chiropractic can be very helpful, especially when it’s combined with physical therapy and stretching exercises.”
A 2010 study published in Medscape reviewed more than two dozen published deaths after chiropractic treatments, noting that other deaths may have been unreported. The study said that a separate 1997 review of complications after neck manipulations included 177 vascular accidents, 32 of which were fatal. The vast majority of these cases were associated with chiropractic treatment, the study said.
[See: 10 Seemingly Innocent Symptoms You Shouldn’t Ignore.]
If You’re Considering Seeing a Chiropractor
1. Get a referral from a doctor, a relative or a trusted friend. Read the chiropractor’s website, including patient reviews. Meet with the chiropractor to discuss his or her treatment philosophy, says Keith Overland, a past president of the American Chiropractic Association and a chiropractor in Norwalk, Connecticut. Ask about the various types of treatment the chiropractor provides and possible adverse effects.
2. Be aware that some doctors recommend patients avoid neck manipulations because of the risk they can rupture an artery, which can lead to a stroke. Also, be on the lookout for symptoms that may necessitate the need to go to an emergency room rather than to a chiropractor, physicians and chiropractors say. For example, many patients seek chiropractic work for headaches. However, if someone has a severe headache that developed quickly, as well as odd sensations in their face, those could be possible symptoms of the early onset of a stroke, says Tuck. “Many of these symptoms could mean someone is a great candidate for chiropractic care. But it’s my job to get the patient to the right place, whether it’s the emergency room, their family doctor or some other specialist.”
[See: 5 Physical Therapy Procedures You Should Question.]
3. Consider seeing an osteopath. Osteopaths can manipulate the neck without risk of a serious injury, says Dr. David Borenstein, director of the New York Stem Cell Treatment Center in New York City. Unlike chiropractors, osteopaths are fully licensed physicians who can practice in all areas of medicine. They receive special training in the musculoskeletal system, which connects the body’s system of nerves, muscle and bones. During their medical training, osteopaths spend time in operating rooms and intensive care units, which gives them an edge over chiropractors, Borenstein says.
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The Pros and Cons of Seeing a Chiropractor originally appeared on usnews.com
