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The Adjustment Argument: Did a chiropractic neck adjustment cause a Morton woman’s stroke?

A Morton woman's family says she suffered a stroke at the young age of 38, just one day after a visit to the chiropractor. It affected her speech, memory, and motor skills.

Amber Thomas before the stroke

It happened more than 2 years ago in the family's former home, one they were forced to put up for sale after the stroke because Amber could no longer easily navigate the stairs.

Amber had gone to a Peoria chiropractor for a routine adjustment. Her husband John recalls she was fine when she came home that night.

"She sat on the couch with me that night at the end of the night after putting Fin down and said, 'boy my neck feels better.' She said, 'boy you should’ve heard the pop! It was really loud this time,'" John recalls.

But then, the next morning John says she woke up and reported feeling ill. She told him she was dizzy and her hands felt numb, and was going to stay home from work to see the doctor. Later he says she called and reported the diagnosis had been an ear infection and fluid in the ears. She came back home and went back to bed, but not before mentioning her vision was also blurry. John says he picked up their young son from daycare and checked in with her, before heading downstairs to let her sleep. And that's when it happened.

"Basically I was here on the floor between the couches playing with Finley. Our master bedroom is right over here over the kitchen, and it was then that I heard her hit the floor," he explains, gesturing to the spots in their now vacant home.

Flashing back to that fateful day, he says he then heard Amber crying incoherently. He grabbed their 16 month old son and raced up the stairs to find amber lying on the floor.

The 911 recording from that night captures the terror he faced when he found her unresponsive.

911 CALL:
"Tazewell County 911?"

John: "Yes, hello, my wife has been ill and she just fell out of bed... She's still breathing but she's unable to talk, she can't squeeze my hand to tell me yes or no, I have no idea if she's understanding what I'm saying..."

Amber was rushed to OSF St. Francis Medical Center where doctors quickly determined she'd suffered a massive stroke. Then, mid surgery, a question her husband wasn't expecting.

"He said, 'John, does your wife see a chiropractor?' And I said, 'Yeah.' And he said, 'When did she see the chiropractor last?' And I said, 'Yesterday.' He said, 'Did she have her neck adjusted' and I said yes. And he said, 'Okay, that’s what I needed to know,' and hung up the phone," John recounts..

That doctor was Deepak Nair, MD, a neurologist at OSF St. Francis Medical Center.

"Several times a year we will see often young people who have had some sort of stroke, either immediately after having chiropractic care or very soon after within the first few days," Dr. Nair says, estimating he sees roughly 6 cases a year.

Deepak Nair, MD
OSF St. Francis Medical Center Neurologist

He goes on to explain he believes neck adjustments are partially to blame, especially when it comes to tears in the vertebral arteries. And he says it's more likely to affect younger patients, since your arteries lengthen and gain more elasticity as you age.

"The artery is passing through these little openings in the bones of the cervical spine. And so if you then turn the head further left or further right we’re going to induce more stretch injury and now you’re bending an artery over these hard pieces of bone," Nair outlines, pointing to a diagram for reference.

For Amber, it was actually her carotid artery, which is encased in soft tissue. But Nair theorizes if enough plaque was built up inside, a stretched artery could tear on that calcified plaque.

"Either the manipulation caused the injury to the artery itself or it worsened an existing injury there," he states when asked what he thinks caused Amber's stroke.

Amber Thomas at OSF St. Francis Medical Center, post stroke

However these are theories disputed by many in the chiropractic community.

While Peoria Chiropractor Chad Walker was not involved in Amber's case, he still doesn't think it's possible an adjustment caused her stroke.

"No I don’t, and the research doesn’t say that either," states Dr. Walker.

Chad Walker, DC
Peoria Chiropractor

Dr. Nair and the Thomas' want chiropractors to warn patients this is a risk. Dr. Walker says while they would evaluate on a case-to-case basis, warning every patient about something so rare just isn't practical.

"If that were true then neurologists should also say in the same sentence, every primary care physician must disclose the same (risk,) every dentist, every barber, and hairdresser needs to disclose the same risk, because they’ve had this happen in their offices too."

Instead, he believes these are people who were going to have a stroke anyway, suffering from early warning signs like head and neck pain, prompting them to see a chiropractor for relief. He shares he's had patients come to his office with those very complaints only for him to send them to the hospital to be assessed for a stroke. That's why he says chiropractors always assess patients before performing any procedure.

Brandon Steele, DC. a practicing chiropractor out of Belleville, also unaffiliated with Amber's case, agrees with Dr. Walker.

"It’s just that these people are already having a stroke and it’s when they come to see us they were already in the process," says Dr. Steele, who often speaks on behalf of the American Chiropractic Association. He and Dr. Walker also claim that chiropractic neck manipulations don't generate near the force to do the kind of damage to tear an artery.

Brandon Steele, DC
Bellevue Chiropractor, ACA Member

Overall, though, the research is mixed.

For example, a 2011 study by St. Joseph's Hospital and Medical Center in Phoenix found, "Chiropractic manipulation of the cervical spine can produce dissections involving the cervical and cranial segments of the vertebral and carotid arteries." Although it was a relatively small study of 13 patients who experienced adverse effects after chiropractic manipulation, 4 of those (or 31%) were left permanently disabled or died as a result of their arterial injuries.

Another study out of the UK in 2010 that looked at 26 deaths blamed on accidents involving the dissection of the vertebral artery also concluded "numerous deaths have occurred after chiropractic manipulations," adding, "the risks of this treatment far outweigh its benefits."

But, a Canadian study published in 2008 likened the relationship to the chicken and the egg debate, questioning which came first. The authors reasoned these incidents were "...likely due to patients with headache and neck pain... (from vba dissection) seeking care before their stroke," finding "..no evidence of excess risk of VBA stroke associated (with) chiropractic care compared to primary care."

And another recently published article in the Annals of Medicine reached the conclusion that "there is no firm scientific basis for direct causality between cervical spinal manipulative therapy and cervical artery dissection." It also found the rate of Cervical Artery Dissection to be "relatively low," 2.9 per 100,000 people per year in the general population."

"There is no cause and effect relationship with stroke," cites Steele, referring to that last study.

But the Thomas' and Dr. Nair aren't so sure.

"And if people are really eager to pursue chiropractic care, my recommendation is as long as they stay below the neck that should be fine," shares Dr. Nair.

It's something John shares with others, encouraging them to talk to their primary care doctor before visiting a chiropractor, advice he says he wishes Amber had received years ago.

"Almost all our shared history is gone. She doesn't... she doesn't remember when we got married, those memories of our shared history.. our son being born? That stuff's gone," John painfully reveals, choking back tears.

Amber, John and Finley before the stroke

Meanwhile the family is pursuing a lawsuit against the chiropractor who treated Amber, which is one of the reasons they declined to name that provider in our report. They also said they want the focus to be on raising awareness and encouraging people to talk about risks, no matter how rare.

As for those who feel they're getting relief from a contractor and want to continue seeing that provider but have concerns about neck adjustments, chiropractors say there are alternative techniques that use less force, although they say they may take longer to be effective.
For a look at special web extras demonstrating some of those techniques:

Additional medical positions on the subject:

According to Mayo Clinic: "Serious complications associated with chiropractic adjustment are overall rare, but may include: 'a certain type of stroke (vertebral artery dissection) after neck manipulation.'"

From the ACC (Association of Chiropractic Colleges) : When it comes to consent, they say "The doctor should obtain informed consent from patients before carrying out any diagnostic or therapeutic procedure on patients..." that includes telling them about ".. the potential benefits and risks of the procedure..."

The American Heart Association/American Stroke Association states online, in relation to "Cervical Arterial Dissections and Association with Cervical Manipulative Therapy: "While current biomechanical evidence is insufficient to establish the claim that CMT causes CD, clinical reports suggest that mechanical forces play a role in a considerable number of CDs and most population controlled studies have found an association between CMT and VAD strokes in young patients."

As a result, they recommend "... practitioners should strongly consider the possibility of CD as a presenting symptom, and patients should be informed of the statistical association between CD and CMT prior to undergoing manipulation of the spine."

Caitlin Knute

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