Chiropractic and Stroke
Chiropractic and Stroke
There is lack of compelling evidence that SMT is causally associated with stroke. Physical triggers, including SMT, can serve as plausible final link between the underlying disease and stroke (for instance, in case of arterial dissection with existing connective tissue weakness). It appears few of Hill's criteria for causality appear connected with VAD and chiropractic. There may be some links or association with SMT and VAD in untrained practitioners, but this has not been established with chiropractors. The quality of evidence suggesting causation between chiropractic and VAD is mostly weak. Therefore, causality between chiropractic and vascular accidents has not been determined.
It is possible that healthcare practitioners are not taking a thorough history to determine the cause of the VAD after SMT. Healthcare practitioners are probably missing many clinical facts, because they now only record the patient having SMT. They should enquire about other possible causes or circumstances for VAD. This may include minor neck trauma, a change in chronic neck pain or headache, recent infection or other predisposing lifestyle factors such as smoking, hyperlipidaemia, hypertension, and hyperhomocysteinaemia. Therefore, it is important that healthcare practitioners take a thorough clinical history to determine the cause of VAD.
Systematic prospective studies are needed to assess the safety of cervical spine SMT with regards to cerebrovascular events. Such studies should also account for the education of the practitioner.
Conclusion
There is lack of compelling evidence that SMT is causally associated with stroke. Physical triggers, including SMT, can serve as plausible final link between the underlying disease and stroke (for instance, in case of arterial dissection with existing connective tissue weakness). It appears few of Hill's criteria for causality appear connected with VAD and chiropractic. There may be some links or association with SMT and VAD in untrained practitioners, but this has not been established with chiropractors. The quality of evidence suggesting causation between chiropractic and VAD is mostly weak. Therefore, causality between chiropractic and vascular accidents has not been determined.
It is possible that healthcare practitioners are not taking a thorough history to determine the cause of the VAD after SMT. Healthcare practitioners are probably missing many clinical facts, because they now only record the patient having SMT. They should enquire about other possible causes or circumstances for VAD. This may include minor neck trauma, a change in chronic neck pain or headache, recent infection or other predisposing lifestyle factors such as smoking, hyperlipidaemia, hypertension, and hyperhomocysteinaemia. Therefore, it is important that healthcare practitioners take a thorough clinical history to determine the cause of VAD.
Systematic prospective studies are needed to assess the safety of cervical spine SMT with regards to cerebrovascular events. Such studies should also account for the education of the practitioner.
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