Can chiropractors cause strokes
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Can Chiropractors Cause Strokes?
Introduction to Chiropractic Care and Stroke Risk
Chiropractic manipulation is a common treatment for neck pain and headaches. However, there has been ongoing debate about whether these treatments can increase the risk of strokes, particularly those involving the vertebrobasilar artery (VBA) and carotid artery. This article synthesizes findings from multiple studies to address the question: Can chiropractors cause strokes?
Carotid Artery Stroke and Chiropractic Care
Population-Based Case-Crossover Study
A study conducted in Ontario, Canada, aimed to assess the risk of carotid artery stroke following chiropractic care. The study compared the association between chiropractic and primary care physician (PCP) visits and subsequent strokes. The results indicated that there was no excess risk of carotid artery stroke after chiropractic care. The associations found between chiropractic and PCP visits and stroke were similar, suggesting that patients with early dissection-related symptoms were seeking care before developing their strokes.
Vertebrobasilar Artery (VBA) Stroke and Chiropractic Care
Case-Control Studies
Several studies have investigated the relationship between chiropractic care and VBA stroke. A case-control study in the U.S. found no significant association between chiropractic visits and VBA stroke in both commercially insured and Medicare Advantage populations. The study concluded that manipulation is an unlikely cause of VBA stroke, and the positive association between PCP visits and VBA stroke is likely due to patients seeking care for symptoms of arterial dissection.
Population-Based Case Series
Another study described the characteristics of Ontario VBA stroke patients who consulted a chiropractor within the year before their stroke. The findings suggested that most patients had at least one cerebrovascular comorbidity, and the association between chiropractic care and VBA stroke is likely coincidental, reflecting the natural history of the disorder.
Case-Crossover Analysis
A comprehensive study involving 818 VBA stroke cases found that patients under 45 years old were more likely to see a chiropractor or PCP before their stroke compared to controls. However, there was no increased association between chiropractic visits and VBA stroke in those older than 45 years. The study concluded that the increased risks associated with chiropractic and PCP visits are likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke.
Risk Assessment in Older Adults
Medicare Beneficiaries Study
A study focusing on Medicare beneficiaries aged 66 to 99 years with neck pain found that the incidence of vertebrobasilar stroke was extremely low. The study reported small differences in stroke risk between patients who saw a chiropractor and those who saw a PCP, which were not clinically significant.
Conclusion
The current body of research suggests that there is no significant excess risk of stroke associated with chiropractic care compared to primary care. The associations observed between chiropractic visits and stroke are likely due to patients seeking care for early symptoms of arterial dissection rather than the chiropractic manipulation itself. Therefore, while the risk of stroke following chiropractic care cannot be entirely ruled out, it appears to be very low and comparable to the risk associated with visits to primary care physicians.
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