Deadly twist: Neck adjustments can be risky

Dr. Kazmi examined her only a few minutes before he escorted her across the street to Montefiore Medical Center, where doctors took scans of her neck and brain. “Christa is lucky to be alive,” he says. “I knew the moment I saw her that she had had a stroke.” And he is convinced that the stroke was caused by Heck’s neck adjustment, which tore a critical artery that keeps blood flowing to the brain. “I see at least two cases like this or worse a year,” Dr. Kazmi says. “Cervical manipulation is a preposterous thing to do, and it should be banned.”

Americans make some 250 million visits to a chiropractor each year, and 105 million of those appointments include neck manipulations, according to the American Chiropractic Association in Arlington, Virginia. In addition to being used for neck, back and headache pain, the treatment is purported by some chiropractors to ease ailments as diverse as asthma, PMS and attention deficit disorder.

Chiropractic theory holds that when vertebrae become misaligned, they may put pressure on nerves along the spine, interrupting the nerves’ signals to the rest of the body. “Through improving the functioning of the joints, you are at the very least improving overall health,” says ACA spokesman William J. Lauretti, assistant professor at New York Chiropractic College in Seneca Falls. “When a spinal joint is not functioning properly, it’s a chronic irritant to the nervous system.”

Introduced in the late 19th century by the founder of chiropractic medicine, Daniel David Palmer — a Canadian schoolteacher who became famous for his healing touch — neck adjustments are given routinely and repeatedly by U.S. chiropractors, as well as some physicians, physical therapists and massage therapists. But despite patients’ enthusiasm for the neck adjustment — 45 percent of respondents to a Self.com poll said they had seen a chiropractor — researchers have not produced definitive proof of its medical value.

In 1996, several chiropractic groups commissioned a study from the Rand Corporation, an independent research company in Santa Monica, California; Rand reported that there have not been enough studies to show long-term benefits from cervical manipulations for neck, head and shoulder pain and only sparse evidence of short-term relief. A 2005 study in the Journal of Manipulative and Physiological Therapeutics reached a similar conclusion. Earlier this year, an evaluation of chiropractic visits and other complementary treatments for lower-back pain conducted by Harvard Medical School in Boston found the therapies “did not result in clinically significant improvements in symptom relief or functional restoration.” (The researchers did not track whether patients were getting neck adjustments specifically, but the ACA estimates 42 percent of appointments include them.)

What neck adjustments can do
In Self’s online poll, more than 20 percent of women who visited the chiropractor said they felt no better afterward. Eight percent said they felt worse. Injuries that can occur on a chiropractor’s table include soft tissue damage, joint dislocations and bone fractures in the neck and back. The most common problem is disk injury in the neck or lower back, which can be extraordinarily painful. (In 1999, Karen Santorum, wife of former Pennsylvania Senator Rick Santorum, won $175,000 in court after suffering a herniated disk at the hands of a chiropractor.) But only neck manipulation, not back adjustments, can cause the life-altering side effect Christa Heck had.

According to Heck’s medical records, the chiropractor’s neck adjustment left a 4.5-centimeter tear in her left vertebral artery, one of four pathways that control blood flow to the brain (the others are the right vertebral artery and the left and right carotid arteries).

How a neck crack leads to a stroke Chiropractic theory holds that adjusting the cervical spine can ease pain. However, this action may tear one of the vertebral arteries, which run through either side of the spine and provide blood to the brain. In rare cases twisting can tear the nearby carotid arteries. If the whole artery or its inner lining tears, a blood clot may form. If a clot moves into the brain via the cerebral arteries, the result is a stroke. Source: Self

Extreme or abrupt twisting of the neck can damage the inner layer of these arteries, creating a blood clot. If the clot travels north, it can cut off blood flow to part of the brain — the definition of a stroke. In fact, Dr. Kazmi believes Heck had two strokes, one the day after her first neck adjustment, and another immediately following her second. “The damage was done after the first manipulation, then she started throwing clots,” he says.

Heck’s chiropractor (who Heck asked not be identified for fear of jeopardizing a legal settlement) said through his lawyer, Stephen P. Haber of White Plains, New York, that Heck’s version of events was contradicted by “sworn deposition testimony, records of care and test results to say nothing of established principles of chiropractic and medical science” and that he looks forward to trying the matter in court.

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