MD, PhD, FMedSci, FSB, FRCP, FRCPEd

We all hope that serious complications after chiropractic care are rare. However, this does not mean they are unimportant. Multi-vessel cervical dissection with cortical sparing is an exceptional event in clinical practice. Such a case has just been described as a result of chiropractic upper spinal manipulation.

Neurologists from Qatar published a case report of a 55-year-old man who presented with acute-onset neck pain associated with sudden onset right-sided hemiparesis and dysphasia after chiropractic manipulation for chronic neck pain.

Magnetic resonance imaging revealed bilateral internal carotid artery dissection and left extracranial vertebral artery dissection with bilateral anterior cerebral artery territory infarctions and large cortical-sparing left middle cerebral artery infarction. This suggests the presence of functionally patent and interconnecting leptomeningeal anastomoses between cerebral arteries, which may provide sufficient blood flow to salvage penumbral regions when a supplying artery is occluded.

The authors concluded that chiropractic cervical manipulation can result in catastrophic vascular lesions preventable if these practices are limited to highly specialized personnel under very specific situations.

Chiropractors will claim that they are highly specialised and that such events must be true rarities. Others might even deny a causal relationship altogether. Others again would claim that, relative to conventional treatments, chiropractic manipulations are extremely safe. You only need to search my blog using the search-term ‘chiropractic’ to find that there are considerable doubts about these assumptions:

  • Many chiropractors are not well trained and seem mostly in the business of making a tidy profit.
  • Some seem to have forgotten most of the factual knowledge they may have learnt at chiro-college.
  • There is no effective monitoring scheme to adequately record serious side-effects of chiropractic care.
  • Therefore the incidence figures of such catastrophic events are currently still anyone’s guess.
  • Publications by chiropractic interest groups seemingly denying this point are all fatally flawed.
  • It is not far-fetched to fear that under-reporting of serious complications is huge.
  • The reliable evidence fails to demonstrate that neck manipulations generate more good than harm.
  • Until sound evidence is available, the precautionary principle leads most critical thinkers to conclude that neck manipulations have no place in routine health care.

102 Responses to Catastrophic outcome of chiropractic spinal manipulation

  • Where is Critical_Chiro to tell us, once again, about his heroic attempts to reform this stupid and unnecessary abuse of the term healthcare by chirocrooks?

  • Like in my case: A forced hyperflexion-manipulation of my neck left me with a posterior/superior sternoclavicular dislocation.

    I know on 2 occasions this has happened before, where chiropractic manipulations has produced sc dislocations.
    Nettles: sternoclavicular dislocations 1968

    • I agree, I have utilized chiropractic for many years, and did not know of the dangers of letting someone manipulate this area.I have been crippled with severe headaches, neck pain, base of skull pain, nausea, and numbness and tingling.It has been 4weeks, this is bad, I have been dedicated to keeping this problem in check and I wish someone would hold some of these, “incompetent chiropractors” accountable.It should be a serious,” no “that I have had a history of headaches and neck pain, my whole life.He should pay for testing and any therapy I choose.

  • This article referred to ‘chiropractic manipulations’ – but really there is no such thing.
    Just ‘manipulations’ – ‘carried out by a chiropractor’ if you will.
    I challenge anyone to distinguish between a cervical manipulation carried out by a chiropractor, a physiotherapist, or a registered medical practitioner (some of whom manipulate under anaesthesia).

    Having seen a case referred in to my tertiary centre by an orthopaedic surgeon who manipulated – and only then, when the patient experienced a degree of paralysis, carried out an x-ray and discovered a tumour (necessitating trans-oral surgical stabilisation), I must counsel that many items in Edzard’s list apply also to ‘Medicine’:

    ” * There is no effective monitoring scheme to adequately record serious side-effects of care.
    * Therefore the incidence figures of such catastrophic events are currently still anyone’s guess.
    * It is not far-fetched to fear that under-reporting of serious complications is huge. (No quite so true for ‘Medicine’).
    * The reliable evidence fails to demonstrate that neck manipulations generate more good than harm.
    * Until sound evidence is available, the precautionary principle leads most critical thinkers to conclude that neck manipulations have no place in routine health care.”

    But the biggest complication of chiropractic is that it is generally carried out without the patient giving properly informed consent – without appreciating that ‘chiropractic’ is a faith, that “Chiropractic is a different system to medicine” (DD Palmer) and that there is a lack of any plausible evidence that ‘innate’ is ever released and thereby beneficially affects somatic structures.
    (If chiropractors do not release ‘innate’, they can hardly be said to be chiropractors and are just manipulators who are not qualified in medicine or physiotherapy).

    For all its faults, ‘Medicine’ does its damndest to raise quality, see that doctors practice with integrity, and ensure that those who have mishaps do not practice un-acceptable techniques again.
    (Which is what happened in the case I cite).

    • Consent is good, especially if everybody comes to an agreement how much information it should contain because I have experienced that the length of patient information sheet (or part) for the same procedure may differ significantly depending on the clinic, however, the question is also how information should be presented. E.g. a person who wants to get rid of pain may consider that, since dissection is so rare, who cares! If dissection and its consequences is described in all details, patient may get scared and leave, which is good, however, many do not like to read long texts that are scary and contain terminology….

    • All cervical manipulations are not the same between professions that utilize manipulation as a therapeutic technique. Chiros will hyper extend the crevical vertebrae and apply a high velocity low amplitude twist to the highest neck when a patient is least expecting the HVLA twist and therefore unable to resist. It is at the C1 and C2 area of the high neck where the arteries make a horizontal turn that dissections occur from chiropractic HVLA manipulations. Physiotherapists do no utilize a hyperextended HVLA twist of the highest neck….their manipulations are slow, gentle and not of the highest neck region

      • Really? Check out this PT site

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        Learn spinal manipulation and dry needling from the experts! The American Academy of Manipulative Therapy is dedicated to teaching physical therapists, osteopaths and medical doctors the science and art of thrust manipulation and dry needling.

        Distinguish yourself as an expert in both HVLA thrust manipulation and dry needling by earning a DIPLOMA in OSTEOPRACTIC™. Get CERTIFIED in SPINAL MANIPULATIVE THERAPY™ (Cert. SMT) by completing SMT-1 to 4 of the OSTEOPRACTIC™ HVLA Thrust Manipulation Series. Get CERTIFIED in DRY NEEDLING™ (Cert. DN) by completing the DN-1 and DN-2 dry needling courses.

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        • It’s American and it’s salesmanship. Best avoided at all costs.

        • In Canada we do not have osteopractors….and physiotherapist DO NOT utilize HVLA cervical manipulation….only and I repeat only would a chiropractor risk HVLA thrust of the cervical vertebrae to treat a nonmusculoskelatal conditions or to remove the infamous chiropractic subluxation . And then when an adverse reaction occurs, blame some pre existing condition…a condition that they had no expertise to test for.

  • I would like to see where it said chiropractor caused injury. The full article here.
    http://www.qscience.com/doi/pdf/10.5339/qmj.2015.16

    This may be the cause of the vad.

    “Cervical manipulation is still widely practiced in
    massage parlors and barbers in the Middle East.
    Unaware of potential underlying spinal column or vascular disease, patients have a neck manipulation
    at barber shops even though they are unsure of its
    therapeutic benefit, let alone the potential risk
    involved.”

    I like how chiropractors get the blame for that.

    “A 55-year-old man, smoker, with history of diabetes
    mellitus, hypertension and dyslipidemia, presented to
    the emergency department with acute-onset neck
    pain with associated sudden onset right-sided
    hemiparesis and dysphasia. One week before the
    onset of his symptoms he had cervical manipulation
    for chronic neck pain.”

    He had his neck manipulated. Must have been a chiropractic adjustment, must have been a chiropractor.

    Just shows the usual bias from Prof. Ernst and his clan.

    • ” A 55-year-old man presented with acute-onset neck pain with associated sudden onset right-sided hemiparesis and dysphasia after chiropractic manipulation for chronic neck pain. ”
      “We report a case of bilateral internal carotid artery (ICA)dissection, associated with vertebral artery(VA) dissection following neck manipulation.”
      ” One week before the onset of his symptoms he had cervical manipulation for chronic neck pain.”
      ” A single, unilateral headache or cervical pain in oligosymptomatic cases can be underestimated and only thorough interrogation can expose circumstances related to traumatic etiologies such as chiropractic manipulations that prompt immediate MRI-MRA.”
      ” Unlike spontaneous vertebral dissections which do not show a preferred site of dissection, by far, the most vulnerable site during chiropractic cervical spine manipulation is at the atlanto-axial joint.”
      “The sudden decline of our patient after a period of apparent stabilization confirms that CeAD is highly variable both in presentation and course which is of poorer prognosis if a previous chiropractic maneuver results in bilateral cervical arterial occlusion and stroke, the only independent factors associated with a poor outcome in large studies.”
      “Potentially dangerous chiropractic maneuvers must be avoided, and should be restricted to experts in order to minimize the risks of further cervical vessel lesions.”

    • Notice how brave fedup is in not using his/her own name? I suspect because we could find his/her practice and see what other nonsensical “treatments’ s/he offers for conditions that cannot be treated by chiropractic.

  • Cherry picking. You somehow miss the most important part in this case. The 55 year old had something done to his neck, possibly by a barber. Who decides having your neck pulled is neck manipulation? the author jumps from neck manipulated(by barber) to chiropractic manipulation. There is NO evidence that this study is chiropractic manipulation done by a chiropractor, It’s most likely to be a man who had is neck yanked after having a shave. You can try and label it as chiropractic all you want, as has the author, but it only shows your bias.

    Its very similar to the german study done a few years ago where the title was “chiropractic manipulation causes vad” of course when you actually looked at the facts most vad happened after some sort of manipulation by an orthopedic surgeon. How it became “chiropractic” is beyond me. Its just bias. I will find the study and provide a link.

    • I am not cherry picking but you invited me to provide the quotes.
      By contrast, you are speculating when you claim “the 55 year old had something done to his neck, possibly by a barber.” the article is quite clear: ” A 55-year-old man presented with acute-onset neck pain with associated sudden onset right-sided hemiparesis and dysphasia after chiropractic manipulation for chronic neck pain. ”

  • lol!!! your bias shows itself in so many ways.

    “A 55-year-old man presented with acute-onset neck pain with associated sudden onset right-sided hemiparesis and dysphasia after chiropractic manipulation for chronic neck pain. ”

    It also says this in the case report. “One week before the
    onset of his symptoms he had cervical manipulation
    for chronic neck pain.”

    Was it manipulation, chiropractic, chiropractor, barber, who knows? not you. Assumption it was chiropractic by a chiropractor. Bias

    • you are obviously a chiro!
      if not, the term CHIROPRACTIC MANIPULATION would mean something to you [I am sure it does, if someone says something positive about it – and that, my friend is called BIAS].

      • Maybe there’s some subtle but critical difference between “after chiropractic manipulation” by a chiropractic practitioner and “after chiropractic manipulation” by a practitioner of chiropractic that we’re all missing here, like the difference between “Judean People’s Front” and the “People’s Front of Judea”?

        Perhaps between bouts of poor bladder control, “fedup” might try contacting the paper’s actual authors to clarify precisely what they mean by the phrase “after chiropractic manipulation” in the first line of their abstract, in case they just spelled “barberpractic” wrong?

        • “after chiropractic manipulation” by a chiropractic practitioner and “after chiropractic manipulation” by a practitioner of chiropractic” You could write for monty python. Unfortunately it shows your complete lack of understanding regards chiropractic. It was done by a chiropractor using chiropractic techniques or it wasn’t full stop. You can not have a barber using chiropractic adjustments because that makes it a barber pulling your neck NOT using chiropractic manipulation.

          • I asked you a similar question a few days ago but didn’t get an answer: what is it in ‘chiropractic techniques’ that makes it different to any other manipulation?

          • So what you’re saying is that since the the first line of the paper states that a “chiropractic manipulation” was performed, by definintion the authors are telling us that it was a chiropractor who performed it. Glad we’re all in complete agreement on this; remind us why you’re berating Dr Enrst again?

          • because he just loves criticism and critics of his trade!

          • “You could write for monty python.”

            Oh, the irony.

          • @ fedup on Monday 08 February 2016 at 10:17

            “Unfortunately it shows your complete lack of understanding regards chiropractic.”

            And your post shows a complete lack of understanding of logic. The way you fell into the logical trap set by “has” is pure comedy, nearly as good as the original he cited above.

          • @Alan Henness
             
            “what is it in ‘chiropractic techniques’ that makes it different to any other manipulation?” Probably the same mysterious force that makes a herbal concoction prepared by a homeopath different from a herbal concoction prepared by a herbalist.

  • Please point me to the bit in this study that indicates that the 55 year old man had chiropractic adjustments from a chiropractor.

    I’m not interested in your or the authors biased assumptions. If this study had said “55 year old man visited chiropractor and had neck adjustments from this chiropractor” then would I have posted? No I would accept the facts that on this occasion thats what happened. But you based your blog on “Catastrophic outcome of chiropractic spinal manipulation” yet you have no evidence that chiropractic or a chiropractor was involved. Even though there are several possibilities as to why this man had a vad you decided to blame chiropractic. Bias, poor science.

    • oh dear!
      my title is merely a re phrasing of what the article stated: ‘CHIROPRACTIC MANIPULATION’ !!!
      IS THAT REALLY SO HARD TO UNDERSTAND, IF YOU ARE A CHIRO?

    • Here’s the real story according to „fedup“:
      The man was drinking tea with the chiropractor who complained that the barbers were stealing his clients. Then he went to a barber to try out their services and got manipulated so badly that he got a triple arterial injury. Barbers are of course known for their brutality. Remember Sweeney Todd?
      The lying and cheating doctors who are in cahoots with the barbers then wrote an article and got it published to frame the chiropractors. That’s how it must have happened.

      Oh, and by the way, this is not a study as “fedup” seems to think, it’s a case report. One would have thought chiropractors knew the difference. They say they are more educated than medical doctors.

      • Bjorn, I’m not sure why you felt the need to make up such a story. Its not what I thought. I have no problems with the medical profession, nor barbers. OK it was a study but I don’t sit for hours thinking up how best to reply, I have 5 minutes between the people I see, so I often rush my answers. Sorry. My only complaint is that Prof Ernst for years has talked about poor science, no evidence etc. But often his arguments are as bad. Now this Case report and the study it links to ONLY mention chiropractic because of Prof Ernst systematic review. I’ve already answered about the problem with bias and single author. I am a chiropractor, but I don’t use and have never been taught any rotational, flexion or extension adjustments. So for many years on here and on Pulse I have asked Prof Ernst WHICH chiropractic adjustments are most likely to cause injury/vads. He has case studies and other research pieces citing his research so I would presume he is the best person to answer this question.
        So again Prof Ernst, or maybe you Bjorn, which chiropractic adjustments are, based on your research, most likely to cause injury and should be avoided.

        • should you not presume that this is a question chiros should have answered long ago?
          as far as I can see, the evidence points to manipulations of the upper spine involving abrupt over-extension combined with rotation beyond the anatomical limits.

          • Prof Ernst, I was not asking for your observations. I want evidence that points to a specific type of adjustment/manipulation. For some people who read this blog they think there is no diference between chiropractic, osteopathic, physio or barber manipulation. everybody just manipulates the neck. I, and you, know this is not the case. So saying extension plus rotation, which is like some chiropractic adjustments, is ok but what about flexion and rotation, like another chiropractic adjustment. What about flexion and lateral flexion but no rotation? another adjustment.

            “the evidence points to manipulations of the upper spine involving abrupt over-extension combined with rotation beyond the anatomical limits.” Ok will you please let me know what type of adjustment this is and point me to the evidence that suggests this is the likely mechanism. Then we can all avoid it.

          • you tell me.

          • fedup said:

            For some people who read this blog they think there is no diference between chiropractic, osteopathic, physio or barber manipulation. everybody just manipulates the neck. I, and you, know this is not the case.

            Many have certainly asked, but I’m not sure we ever received a cogent reply. Since you know what the difference is, perhaps you could enlighten us?

  • Wow just been checking that study.

    “Studies have revealed that 28% of strokes following
    CeAD were preceded by chiropractic neck
    manipulation.2”

    so went to that study, funny how chiropractic is not mentioned.

    http://stroke.ahajournals.org/content/45/1/37

    whats even funnier is this study sites another study. Guess who thats by!!!!!

    10. Ernst E. Adverse effects of spinal manipulation: a systematic review.
    J R Soc Med. 2007;100:330–338

    lol.

    • enlighten us: what is so funny about that?

    • whats even funnier is this study sites another study. Guess who thats by!!!!!

      Most scientists recognise expertise in the field they are writing about and quote them as needed. Your attempts at witt are rather pathetic, “fedup”.

      • Bjorn, this blog story and 2 other pieces of research based a conclusion on Prof Ernst systematic review. Now the problem with that is that if a systematic review has only one author it is open to bias. Thats why chocrane stipulate that any systematic review has to have more than one author its the only way to prevent confirmation bias and a whole load of other bias.

        I can’t quite see where your review prof Ernst shows “evidence that Studies have revealed that 28% of strokes following CeAD were preceded by chiropractic neck manipulation”

        As the other 2 studies base this finding on your research can you point me to your evidence?

        • @fedup
          Where are you trying to get with this?
          I have to say, in all honesty that you are making a fool of yourself.

          The scope of the article in Stroke is multiple cervical artery dissections and mentions cervical manipulations in general as one risk factor. There is no reason for them to list or stratify what particular brand of neck-wringers is more or less involved. That they refer to Ernst’s article is self-evident as it is a thorough and important overview and analysis of known adverse events related to cervical manipulations. Ernst was very nice to chiropractors in that article, not incriminating them over other bands of neck-wringers:

          In conclusion, spinal manipulation, particularly when
          performed on the upper spine, has repeatedly been
          associated with serious adverse events. Currently the
          incidence of such events is unknown. Adherence to
          informed consent, which currently seems less than
          rigorous,75 should therefore be mandatory to all therapists
          using this treatment. Considering that spinal manipulation is
          used mostly for self-limiting conditions and that its
          effectiveness is not well established,5 we should adopt a
          cautious attitude towards using it in routine health care.

          The chiropractor who tried in vain to improve my LBP for weeks on end insisted on wringing my neck also, just for pre-emption he said. No informed consent there, or gentle manhandling. A “pop” was expected.
          Had I known then what I know now… I feel lucky :/

          It should be evident by now that you are most probably a chiropractor yourself “fedup”. You writhe about in lame indignation, desperately trying to put up a defense for your vocation. You set fire to strawmen in anguished attempts to divert attention away from the fact that one of your hallmark maneuvers may be, or rather very probably is terribly dangerous – especially it seems, to a subset of young and healthy individuals.
          The case reports abound. Many have been related here in this blog. Have a look below at Katie May’s story. Being rare, probably often a temporal delay in thrombotic event after the VA injury and many victims either dead or brain damaged already, study of causality is extremely difficult if not impossible using formal scientific procedures. Therefore the abundance of case reports, many of which have a very clear relationship to cervical manipulation, be they called chiropractic or something else, will have to be taken extremely seriously

          You or any other chiropractors simply cannot expect to be respected and taken seriously as long as they pretend as if there is no problem and continue to ignore their professional responsibility. It is their task as a profession to take this matter seriously and not only call for, but to initiate action. The very least, the chiropractic community should mandate informed consent world-wide for neck manipulations. The only way chiropractors can rid themselves of this strong and terrible suspicion is to instigate strict, controlled audit and follow up of all cases of cervical manipulation.
          If it turns out, as you are so emphatically insinuating, that it is other brands of neck-wringers who are to blame and not the self-reportedly “gentle and well trained” chiro’s, then you as a group who wants to be taken professionally serious, should be the one’s to take stern action against this ominous peril.

          • Bjorn, what do you say to a chiropractor that doesn’t use rotational neck adjustments?

          • Bjorn, what do you say to a chiropractor that doesn’t use rotational neck adjustments?

            “Good for you to come to your senses. Now how about stopping the rest of the theatrical nonsense? You could train for a genuine healthcare profession – like physiotherapy, for example.”

          • @Bjorn: Actually I believe the correct answer is “I don’t know, what do you say to a chiropractor that doesn’t use rotational neck adjustments?”

            Whereupon our esteemed entertainer responds with a rib-tickling rejoinder that we all find to be a jolly good giggle, after which we politely agree to leave high velocity neck adjustments to those best qualified to perform them.

          • @has
             
            Nice one! But you may be closer to the truth than you realize. See http://northwalesspineclinic.co.uk/home/about

          • Bjorn, and what do you say to a chiropractor who wasn’t trained in rotational neck adjustments so doesn’t and has never used them, BUT has also trained as a physiotherapist and a chiropractor and found the latter to be more effective at dealing with most musculo skeletal problems?

          • “what do you say to a chiropractor who wasn’t trained in rotational neck adjustments so doesn’t and has never used them, BUT has also trained as a physiotherapist and a chiropractor”

            I would ask why someone did this, because it doesn’t make sense.

          • Frank Collins, it really shows how little you know.

          • @ fedup on Monday 15 February 2016 at 10:02

            “Frank Collins, it really shows how little you know.”

            About what? At least both of aren’t real doctors, nor do either of us know much about real medicine.
            Though, I suspect, one of us is enthralled with using the title “Doctor” despite it being worthless in this context.

            By the way, fedup, your interminable arrogance is profoundly misplaced for two reasons; you aren’t very clever, and you practice witchcraft (the second also evidences the first). When you find any solid evidence that faffing about with people’s back cures anything, please call back?

        • No you are wrong again, never used the title Dr.

          It shows how little you know about chiropractic and physiotherapy, why the strawman about medicine? Can’t remember me pretending to be a Doctor of medicine anywhere.

          “I would ask why someone did this, because it doesn’t make sense.” please enlighten oh stupid me why this doesn’t make sense. What evidence do you have to support that argument?

          How many chiropractors do you know? How many physios do you know? How many people that have trained in both do you know?

          • @ fedup on Monday 15 February 2016 at 12:27

            “never used the title Dr”

            Under what tag/title/description do you faff about?
            (Refer to “has on Monday 15 February 2016 at 16:52”, below, why I don’t need to respond to your “fedup on Monday 15 February 2016 at 13:12”. Cherry-picking from you? Who would have thought?)

            “How many chiropractors do you know?”

            Only two; the one who tried to treat me, unsuccessfully, for right sciatica over 30 years ago, and the airhead who used to live across the road.

            “How many physios do you know?”
            Only one; the one who used to successfully treat me 20 years ago. Why do you ask, Two Dogs?

            I didn’t know the doctor who puts camera in both ends of me either, but that didn’t prevent it happening. I don’t know the oncologist who cleared me of anything unusual in the “tunnel”. I didn’t know the anaesthetist either (nice fellow though) but I still went out like a light. I didn’t know the surgeon who chiselled out the inside of my nose, but I can breathe through the right side now. I don’t know the optometrist who will do my eye test today, but I can reasonably assume he or she is competent in the discipline. They all have science-based degrees, with evidence for their methodologies.

            Now, what is the point of your question?

            “How many people that have trained in both do you know?”

            None, and, as I said, “because it doesn’t make sense”. Why anyone would study to obtain a science-based degree which enables one to work in hospitals, for example, and then undertake an alternative non-degree in wacky stuff completely eludes me.

        • Faffing?????? You want evidence for faffing?

          From the NHS website.

          “Positive evidence
          There is good evidence available that chiropractic is an effective treatment for persistent lower back pain.
          This means that scientific trials conducted to investigate the effect of chiropractic on lower back pain found that it did have a beneficial effect.”

          Frank collins, Ignorance. “lack of knowledge or information”

          • Also from the NHS website:

            A 2011 Cochrane review of studies of chiropractic intervention – treatments offered by chiropractors, including spinal manipulation – found that it is not possible to confirm or refute that chiropractic treatments are any more effective than conventional treatments for persistent lower back pain.

            Funny how you omitted that part, not to mention this one too:

            There is some, mostly poor-quality, evidence that manipulation of bones, joints and soft tissue, as practised by chiropractors, may be an effective treatment for some other musculoskeletal problems. These include:

            acute (new-onset) back pain
            acute and sub-acute neck pain
            chronic neck pain when combined with exercise
            shoulder girdle pain
            frozen shoulder
            tennis elbow – when treatment is combined with exercise
            hip osteoarthritis
            knee osteoarthritis – some kinds of knee pain and some kinds of heel pain
            migraine and headache originating from neck problems

            This evidence is not conclusive, and therefore isn’t strong enough to form the basis of a recommendation to use the treatment for these conditions.

            More high-quality research is needed to determine whether manual treatments are effective for these health conditions.

            In other words, o not-so-special snowflake:

            1. Folks with lower back problems are safer going to a qualified physiotherapist who can at least produce a meaningful piece of paper as evidence of their competence, as opposed to dumpster-diving the alt-mess of chiro providers on blind chance you fall under one who doesn’t treat your spine like a bottle top while shilling sacks of outright garbage.

            2. For treating anything else – including neck problems as we’re discussing here – chiropracters aren’t worth tits. And they will remain not worth tits until such time as they toss all the blatant baloney out of their current pseudo-profession and pony up consistent high-quality evidence on anything that might be left. It’s your job, not ours, to differentiate yourselves from every other pseudo-med peddler out there: Evidence or GTFO; it’s not a hard concept to grasp, and even for putty-eared fools like you it’s never too late to start.

  • So to put this into context, your blog is about a case study that is based on a man who had a vad from possibly a barber yanking his neck, as it doesnt actually mention a chiropractor. So the author puts chiropractic manipulation in that study and sites a study that looks at vertebral artery injury and states %28 of cead happen after chiro manipulation. Now if you check that study it also doesn’t mention chiropractic or chiropractic adjustments, it relies on another study done by Prof Ernst.
    LOL a bias full circle.

  • Prof. Ernst

    you have dug yourself into a hole!!!!

    You have lost this argument.

    STOP DIGGING!!!!!!!!!!!!!!!

  • Hi Frank here I am! Saw the article when it came out and waited for it to be posted here!
    @fedup has articulated well the errors that I expected would and were posted!
    Add this case study to the article where the patient described accurately a bog standard levator scapulae stretch used by every profession then the doctor calls it a chiropractic cervical manipulation causing phrenic nerve injury. That study was then cited by radiopaedia.org Pity they did not check the article first! Then everyone performing a levator scapulae stretch would have been informed and patients would benefit!
    An Adverse Event Reporting System is absolutely necessary for every profession, be it chiro, osteo, PT, GP etc and I whole heartedly support its creation, but it must be accompanied by accurate reporting. The above case study is not one of them.
    The case study also stated “In this scenario, it would be worthy to restrict cervical manipulation only to those qualified professionals with medical training, aware of its potential risks.” As this training is a substantal part of the chiropractic curriculum at university I would have to agree with them.

    • “The case study also stated “In this scenario, it would be worthy to restrict cervical manipulation only to those qualified professionals with medical training, aware of its potential risks.” As this training is a substantal part of the chiropractic curriculum at university I would have to agree with them.”

      Medical training? If it was medical training, why are you not a (real) doctor?

  • Katie May Dead – the hot Playboy model died unexpectedly. She is reported to have suffered a stroke and since then given life support until it was removed on Thursday, February 4, 2016.

    Katie May died at a young age of 34. There are certain controversies regarding as to what triggered the stroke. She is reported to have been experiencing neck pain and was then visiting a chiropractor for medical help.

    On her Instagram post last January 31, a follower asked about her neck pain. She simply replied “It still hurts, going back to chiropractor tomorrow xoxoxo”. Given that, she went to the chiropractor on February 1, the very exact day on which she suffered a stroke.

    Read more: http://www.healthaim.com/katie-may-dead-stroke-really-kill-34-year-old-playboy-model/39436#ixzz3zHumRX3y

  • @Frank Collins
    Identifying red flags is very important. Knowing when not to treat and refer off is vital. Working with doctors is vital for best patient care! To not teach this would be negligent! Here it is taught to the chiro students by a medical doctor and she is very tough and skeptical! Ideal!
    As for “why are you not a (real) doctor?”:
    http://edzardernst.com/2015/08/chiropractic-spinal-manipulation-placebo/#comment-70029
    Don’t use the title and have not earned it!
    A standardised AE reporting system is essential. We have had this discussion before:
    http://edzardernst.com/2015/12/vertebral-artery-dissection-after-chiropractic-manipulation-yet-another-case/#comment-72971
    http://edzardernst.com/2015/09/the-risk-of-chiropractic-spinal-manipulations-a-new-article/#comment-69360

    • @ Critical_Chiro on Friday 05 February 2016 at 21:47,

      “Working with doctors is vital for best patient care!”

      I suggest people seeing doctors is “vital for best patient care”.

      “Here it is taught to the chiro students by a medical doctor and she is very tough and skeptical!”

      I she was really sceptical (I eschew American spelling), she wouldn’t be a at chiro school. Perhaps you could point her to this blog so she can see what the problem is?

      “Don’t use the title and have not earned it!”

      Well, at least the last bit is right, but you are addicted to the money (and, I suggest, of being a “healthcare professional” despite no evidence to support it).

      “A standardised AE reporting system is essential.”

      Who is going to do this? Is a fairy going to come at midnight and have over the whole package? No, it is just like everything else about chiro (bleating about lack of recognition, no research, no funding for research, citing of anecdotes, and unsupported claims of efficacy); you expect someone to do it but not you.

      Is it any wonder chiropractic is treated as a joke? Are you oblivious to the obvious?

  • @Edzard
    Seroius fall at photo shoot. Went to hospital emergency and sent home later in the day! Would assume that seroius medical fed flags had been checked as standard? Missed by Dr’s and sent home then goes to chiro!
    http://www.foxnews.com/entertainment/2016/02/05/model-katie-may-dead-at-34-according-to-multiple-reports/?intcmp=hpff
    http://www.tmz.com/2016/02/05/model-katie-may-stroke-fall-photo-shoot/

    • Serious fail at thinking clearly C_C 🙂

      If you want to be taken seriously you have to think before you write.

      Where does it say Dr’s failed to diagnose something?! Neck sprain is a very common occurrence. I have worked in the US and can confirm that if anything, ER physicians over there tend to be overly careful. It is close to impossible that they omitted doing a thorough physical exam, including a full neurological and x-ray of her neck.
      “If it hurts, X-Ray it!” is the mantra in the US.

      Since when does a minor neck injury result in VAD in a young, healthy person? Suffering an injury to the carotid artery from a simple fall and being cleared in an american ER is practically out of the question. The doctor interviewed in the newsreel is not an ER physician or trauma specialist but an eminent rheumatologist[sic] who wanted to sound smart and knowledgeable so he blabbered on about carotid injury. He probably never saw a carotid injury in his life and was happily unaware she had been to see a chiropractor 3 days before the stroke and probably again on the day of it.

      What very likely happened is this:

      She fell and sprained her neck sometime before friday, Jan. 29. She went to the ER and was examined properly and released as is usual with simple, uncomplicated neck sprain. The hospital is in for a fat liability issue if they do not confidently rule out any sign of complication. They said in the newsreel she was released from the hospital. She was still hurting on friday morning after having been “adjusted” as she says in her tweet at 10:30. On monday she is brought in with a massive stroke and dies on thursday.

      Now please tell us dear gentle and well trained chiropractor friends, whom does an american celebrity go to for getting “adjusted”??
      A chiropractor of course.
      She went to see a chiropractor who probably wanted to perform well for this celebrity beauty whom he most likely made sure would return for many more money bringing “adjustments” in the following days. And he most likeley wanted to make sure she would tell all her beautiful friends that he had done a miracle for her (self limiting) neck injury, so he made a big deal of it. (I have been told about and seen scores of YT videos with such exercises in doctor bashing, chiro cheering blabber)
      When the chiropractor went through his theatrical adjustment act, the VA was unduly stretched, causing an intimal tear. The circulation wasn’t compromised right away. It still hurt when she tweeted about it the same morning, so the chiropractor certainly didn’t effectuate any miracle as far as her neck sprain and it may even have felt worse. In her tweet on friday morning, after the “adjustment” she asked for help for the pain!
      I find it likely that she went back to the chiro on monday, but of course this is still not clear. A thrombus (blood clot) may well have been developing in her vertebral artery(-ies?) over the weekend and when it dislodged, perhaps by a repeat “adjustment”, it totally blocked the circulation to central, important parts of her brain. Death was the outcome.

      Cervical manipulation cannot and should not be considered risk free. Hundreds of cases of stoke following shortly or immediately after such a maneuver have been reported, many of them clearly coupled to chiropractors.

      • Addendum:
        I must have scrolled past a sentence. She really went back to the chiropractor. In the link Edzard gave, it states clearly:

        On her Instagram post last January 31, a follower asked about her neck pain. She simply replied “It still hurts, going back to chiropractor tomorrow xoxoxo”. Given that, she went to the chiropractor on February 1, the very exact day on which she suffered a stroke.

        Now I guess it will be hard for fedup to claim she was killed by the barber or C_C to maintain she suffered vascular injury from the fall.

  • @ Bjorn

    What about this case report:

    A 30-year-old woman presented to an emergency department with sudden onset of transient loss of left peripheral vision. Owing to a history of migraine headaches, she was released with a diagnosis of ocular migraine. Two days later, she sought chiropractic care for the chief symptom of severe neck pain. The chiropractor suspected the possibility of vertebral artery dissection (VAD). No manipulation was performed; instead, MR angiography (MRA) of the neck was obtained, which revealed an acute left VAD with early thrombus formation. The patient was placed on aspirin therapy. Repeat MRA of the neck 3 months later revealed resolution of the thrombus, without progression to stroke. This case illustrates the importance for all healthcare providers who see patients with neck pain and headache to be attentive to the symptomatic presentation of possible VAD in progress.

    • And the relevance of this is…?

      If you could cough up hundreds of similar stories like there are stories (mostly confirmed) that have direct relevance to the matter being discussed here, we could have something to talk about.
      There are literally hundreds of incriminating case reports about people having VB stroke shortly or immediately after neck manipulation and they keep coming.
      Those that perform most neck manipulations and should be in the forefront of analysing this scary fact, are CHIROPRACTORS!!
      An article in Stroke told about a study that found that the risk ratio of having visited a chiropractic before having a VAD stroke was 5 in those under 45 yoa. FIVE!!!! Thats a bloody well incriminating finding.
      Let’s see if I can find the article before I have to go and light up the barbecue….

      Yesss… here it is:

      Results—Results for those aged <45 years showed VBA cases to be 5 times more likely than controls to have visited a chiropractor within 1 week of the VBA (95% CI from bootstrapping, 1.32 to 43.87). Additionally, in the younger age group, cases were 5 times as likely to have had ≥3 visits with a cervical diagnosis in the month before the case’s VBA date (95% CI from bootstrapping, 1.34 to 18.57). No significant associations were found for those aged ≥45 years.

      They are quite nice to chiro’s in that article and discuss all kind of problems with finding the ugly truth in this matter. The lack of association in those over 45 is most probably hidden in a much higher base rate.
      The big fat smoking, hot barreled gun is there, for all to see. Now keep that in mind you chiropractors, when you grab the next neck and think hard before you perform the act.

  • has wrote on Sunday 07 February 2016 at 23:28: “…try contacting the paper’s actual authors to clarify precisely what they mean by the phrase “after chiropractic manipulation”…”

    IMO, that would be helpful.

    E-mail: gmelikyan@hmc.org.ga
    Department of Neurology (Medicine), Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar

    Ref: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4719436/

  • Correction: The email address for the authors is E-mail: gmelikyan@hmc.org.qa

    • @Critical_Chiro
      You’re right: it’s a very good article. It concludes we just don’t know the cause of Katie May’s stroke, which was also implicit in Edzard’s original comment.
       
      In light of the many things you’ve told us on this blog, I hope you took note of the following sentences: “It’s not for nothing that I have frequently referred to chiropractors as inferior physical therapists with delusions of grandeur. If you don’t believe me, consider that there is a movement among chiropractors to win the status of primary care provider, a role they are completely unqualified for.”

  • @Frank Odds
    The article weighed the evidence from all sides and is very well referenced. It is one of the reasons I like the Science Based Medicine’s site. They focus more on the BS within medicine than in CAM and are very even handed.
    As for “primary care provider” it all boils down to scope of practice. I focus on chronic musculoskeletal conditions and have built up a large medical referral base as a result of this. Subluxation based chiropractors who think that they are a universal panacea and authorities on vaccination are dangerous lone wolfs!
    As I have consistently said:
    Step 1: Point out the BS and tear it to shreads.
    Step 2: Support the reformers within the profession who are challenging the subluxationists and leading the profession in the right direction. Carpet bombing the profession and making sweeping statements harms the reformers and this is unacceptable collateral damage! Support reform take step 2!

    • For the umpteenth time, C_C, step 2 should be to join a profession like physiotherapy that is not afflicted with the BS that you acknowledge needs “tearing to shreds”.
       
      Your redefinition of a “primary care provider” as someone with a limited scope of practice is ridiculous. The expression clearly refers to someone who can deal effectively with every type of medical problem. Your implication (and statements in other comments) that you would pass on to a doctor someone who had a problem you felt you couldn’t help is not by any stretch of the imagination “primary care”. You are a secondary provider of care in a niche based on unproven principles. Your continued insistence that “Subluxation based chiropractors who think that they are a universal panacea and authorities on vaccination are dangerous lone wolfs!” is not confirmed by even the simplest look-see around chiropractic websites.

    • “Carpet bombing the profession and making sweeping statements harms the reformers and this is unacceptable collateral damage!”

      Why is it everyone else can see it but you?

      If a “profession” needs “reforming”, then it isn’t a profession by normal standards. If the basis of its methodology is founded of “innate energy”, as many still believe, where is the scientific basis for its fundamentals? If a group of professionals cannot even agree on what constitutes their raison d’etre, do they have the right to be recognised as a profession? If they cannot do meaningful research, or even commit to it, where is the evidence they should faff around with people’s spines? If they want to lay claim to the title Doctor but don’t cut skin, prescribe drugs, or can diagnose an illness, where is their credibility? If they claim to be “primary care providers” (as stated by FO above) but cannot provide primary healthcare, who can be surprised these claims are met with derision?

      The only problem is chiropractic itself; untested, founded on superstition by a convicted conman, based on a non-existent condition, and practiced by countless charlatans invoking “treatments” with little handheld clicky things.

      Seriously, what is there to reform, except to abolish the nonsense?

  • @Both Franks
    You have both just focused on the 15-18% and ignored the majority of the profession. I have cited multiple articles from Australia, Europe, USA and Canade supporting this percentage in the past and I have cited the research and research gate profiles of chiropractic researchers who are doing the research you and I both demand, yet you ignore it! Step 2 requires support for reform and the reformers, otherwise its carpet bombing and painting the whole profession with a broard brush!
    I think you are confusing “primary contact” with “primary care”. I specialise in chronic musculoskeletal conditions and my referring doctors acknowledge this with their referrals. If I sprouted any BS they would cut me off at the knees instantly! I am a primary care musculoskeletal practitioner, not a primary care health practitioner, there is a big difference! There is a level of acccountability implicit in that referral relationship that is in the patients best interests. I also pick up serious spinal pathology several times a years and immediately refer. The doctors are well aware of the different factions within chiropractic and refer accordingly! This is no different to their referring to a specialist. They know who is good and who is to be avoided as the referral reflects straight back on them! If I cannot help the patient they have referred then I send them back with a detailed report. This generates more referrals, not less! Why? The answer is rather obvious!
    Every profession is evolving, changing and reforming! Not to do so is stagnation and the subluxationists have been stagnant for over 100 years. The rest of the profession has moved on!
    You focus on the BS and demand reform, which is an important part of the reform process. Then dismiss the researchers and reformers who are leading the reform process!
    As for the title doctor, I do not use it and have not earned it. Creates confusion with patients!

    • Critical_Chiro wrote: “You have both just focused on the 15-18% and ignored the majority of the profession.”

      It’s far more than 15-18% who make up the quack chiropractic element. See here:
      http://edzardernst.com/2014/11/the-tolerance-of-quackery-renders-chiropractic-a-profession-of-quacks/#comment-62303

      Current estimates put it at least 60% – and that figure is derived from the chiropractors who are prepared to admit to their quackery:
      http://edzardernst.com/2013/03/what-is-next-a-royal-college-of-window-salesmen/#comment-54269

      Critical_Chiro wrote: “The rest of the profession has moved on!”

      No, it hasn’t. That’s simply wishful thinking. If it moved on, most chiropractors would have to face this disastrous scenario:

      Quote
      “If a chiropractor limited his practice to musculoskeletal conditions such as simple backaches, if he were able to determine which patients are appropriate for him to treat, if he consulted and referred to medical doctors when he couldn’t handle a problem, if he were not overly vigorous in his manipulations, if he minimized the use of x-rays, and if he encouraged the use of proven public health measures, his patients would be relatively safe. But he might not be able to earn a living.”

      Ref: Stephen Barrett MD in the ‘Spine Salesmen’ chapter of the book, ‘The Health Robbers: A Close Look At Quackery In America’. The entire chapter can be read online here: http://www.chirobase.org/12Hx/hr76.html

    • ” I am a primary care musculoskeletal practitioner”. Right, and a homeopath is a “primary care self-healing provider”, a gua sha practitioner is a “primary care surface microperfusion provider”.
       
      When a doctor refers a patient to you, you are in fact a secondary provider of what you do. If all your patients came to you by the secondary referral you so often describe in your comments, my level of concern might be less. It’s the fact that you also take people straight off the street that is the greatest worry, because — like you say — you are not a doctor (nor am I, BTW). If you were as thinking and critical as you claim to be, you would immediately send to a proper doctor every person who comes to you directly, and wait for a back referral (pun intended).

    • CC
      “You focus on the BS and demand reform, which is an important part of the reform process. Then dismiss the researchers and reformers who are leading the reform process!”

      Me
      “Seriously, what is there to reform, except to abolish the nonsense?”

      CC
      “the subluxationists have been stagnant for over 100 years.”

      Me
      Who are you kidding? I’ve waded through plenty of chiro web fantasy lands and seen references or allusions to subluxations. Bjorn has posted videos of some crazy woman who uses a handheld clicky thing on kids. The very idea of treating kids is ridiculous, but many do. Chiro “schools” have developed courses in skimming parents for faffing about with kids.

      Are you that blind?

  • You may be right Edzard when you say “Some chiropractors seem to have forgotten most of the factual knowledge they may have learnt at chiro-college”. Even you would agree “Arterial Dissection” is not a common event post manipulation. For it to occur bilaterally (it happening 2 times) would take some force. For it to happen in the carotid artery would need considerable trauma like choking someone, as this artery is anterior to the cervical spine and I would have thought a patient would have noticed an anterior force to the neck, I am not aware of any technique that would manipulate a spinal joint from the front, when these joints are posterior to the cervical spine. A more likely scenario is this patient had a whiplash and went to a chiropractor for treatment for neck pain some days later. http://www.bjj.boneandjoint.org.uk/content/jbjsbr/91-B/4/536.full.pdf Nevertheless I dont think anyone can draw conclusions from this study without a much more comprehesive history

    • @ Richard Lanigan on Monday 15 February 2016 at 15:48

      From your website; http://chiropracticlive.com/category/vertebral-subluxation/

      “The Vertebral Subluxation Complex Theory.

      The theory on which DD Palmer based his original hypothesis in 1895 that there was a relationship between a vertebra and Harvey Lillards ability to hear.

      We now know spinal joint dysfunction effects how impulses from mechano receptors from the joints enter the central nervous system which regulates the systems the human body requires for optimal wellbeing”

      “This article in Dynamic Chiropractic is just another piece, adding to a “growing body of evidence” supporting the theory of the Vertebral Subluxation Complex….”

      As you are a subluxationist, I now know not to read anything you post. When you find the mythical subluxation, please tell the world as loudly as you can?

      Also from that website, “The Pharmaceuticle Industry”. Gawd, you are a dill.

  • @FrankOdds
    When it comes to musculoskeletal conditions and education, some articles of interest!
    The inadequacy of musculoskeletal knowledge in graduating medical students in the United Kingdom.
    http://www.ncbi.nlm.nih.gov/pubmed/25834088
    The inadequacy of musculoskeletal knowledge after foundation training in the United Kingdom.
    http://www.ncbi.nlm.nih.gov/pubmed/19880882
    Musculoskeletal medicine: an assessment of the attitudes and knowledge of medical students at Harvard Medical School.
    http://www.ncbi.nlm.nih.gov/pubmed/17457065
    Adequacy of education in musculoskeletal medicine.
    http://www.ncbi.nlm.nih.gov/pubmed/15687152
    Design, implementation and prospective evaluation of a new interactive musculoskeletal module for medical students in Ireland.
    http://www.ncbi.nlm.nih.gov/pubmed/23054476
    The Adequacy of Medical School Education in Musculoskeletal Medicine
    http://jbjs.org/content/80/10/1421.abstract
    When a doctor refers to me its because it is my specialty! Additionally, if it is not musculoskeletal I refer straight to the doctor!
    @FrankCollins
    I am aware of the BS and actively campaign against it!
    The subbies have shouted loudly their dogma for 100+ years yet the primary reason for a patient to seek out a chiropractor is for back pain! Their message has not gotten through!
    The subbies have been booted out of the majority of universities and schools, that is why there has been a surge in their love fests like CalJam, DG, Mile High, Edinburgh Lectures and their latest tripe “Rubicon” in London! They feel threatened, which is good!
    “Seriously, what is there to reform, except to abolish the nonsense?” Carpet Bombing! The reform is already here! Support it!

    • “Support it!”

      Support what? One form of nonsense or reformed nonsense? Yeah, great choice.

      I won’t ever go to a chiropractor while my derriere points down. The only people I know who do aren’t very bright.

      • @FC
        Carpet Bombing!
        “The only people I know who do aren’t very bright.”
        Classic Ad Hominem attack!
        https://yourlogicalfallacyis.com/ad-hominem

        • Do you not read any of the prof’s posts? If so, you would have seen in clear type the evidence available to validate chiropractic as a form of treatment.

          As you either didn’t read it or your (read, all chiro’s) subliminal cherry-picking meant it bypassed your cognitive brain, I will repeat it;

          THERE IS NO EVIDENCE TO SUPPORT THE EXISTENCE OF CHIROPRACTIC.

          I will, therefore reiterate;
          “Support what? One form of nonsense or reformed nonsense? Yeah, great choice.”

          “Classic Ad Hominem attack! https://yourlogicalfallacyis.com/ad-hominem

          Gawd, you can’t even get that right; it is “poisoning the well’.

    • Critical_Chiro
       
      Your references demonstrate that musculoskeletal medicine is a lightly taught speciality in medical schools both sides of the Atlantic. The same applies to many other medical subdisciplines. But I bet if you ask a final-year medical student or a foundation trainee whether conditions ”including asthma, infant colic, irritable bowel syndrome (IBS) and many others” result from musculoskeletal disorders you will get mostly accurate responses.
       
      I’d disown any doctor who referred me to a chiropractor. Musculoskeletal aches and pains are the province of orthopaedic medicine. Chiropractic is the province of pseudo-medical practitioners. Far more chiros than you will admit believe in the founding principles pulled from his fundament by one DD Palmer, a person with zero medical training. If you see yourself as a “musculo-skeletal specialist” then train to be an orthopod. Spearhead the revolution you claim to preach by leaving the nonsense and learning some proper medicine.
       
      “Additionally, if it is not musculoskeletal I refer straight to the doctor!” But you don’t have the knowledge or training to recognize for sure when something is not musculoskeletal.

  • @FO
    The average GP is lightly taught and hates seeing those frustrating chronic backs that are not yet at the point of needing an orthopod or neurosurgeon. This is where both chiro’s and physio’s are appropriate!
    As for those other conditions, my response would match the final year med students!
    “Musculoskeletal aches and pains are the province of orthopaedic medicine.”
    If a GP wasted an orthopods time with aches and pains I would love to see the return letter or even more entertaining the phone call! Chronic aches and pains are the province of chiro’s and physio’s and most GP’s are happy to offload those frustrating patients!

    @FC
    “Support what? One form of nonsense or reformed nonsense? Yeah, great choice.”
    Again, Carpet Bombing! If you want change support the reform process and the reformers!

    • @C_C
      “If a GP wasted an orthopods time with aches and pains I would love to see the return letter or even more entertaining the phone call! Chronic aches and pains are the province of chiro’s and physio’s and most GP’s are happy to offload those frustrating patients!”
       
      Your use and non-use of apostrophes is interesting. There is no robust evidence that spinal manipulation does anything for aches and pains. As you’ve been told in this blog time and time again, chiropractic is a theatrical placebo, and if you think otherwise you are not the critical person you claim to be.
       
      Now you give us the confirmation: the patients referred to you are GP offloads. They may well benefit temporarily from your theatrical placebo work, but how do you know they won’t do better with acupuncture, or reiki or homeopathy? Many chiros seem to embrace other forms of pseudo-medicine (another reason a genuinely critical person wouldn’t get into chiropractic in the first place). Have you ever tried a bit of mystic hand-waving with your patients? Tell them it’s a new technique devised by critical chiropracticists. How about holding a hot-water bottle to a patient’s aching back for half an hour, but not an ordinary hot-water bottle; one that’s filled with a homeopathic medicine? The scope for fantasy in successul therapy of minor complaints is unlimited.

  • @FO
    “Offloads”= Dr’s couldn’t help patient!
    The first few patients are indeed horror backs that the doctor is happy to offload. I often think its a case of “So smart arse you want referrals well lets see what you can do with these horrors!” This then changes over time. Once my reputation was established in the local medical community I then started getting referrals from doctors I have never even heard of!
    As for the rest of the BS your trying to label me with, never use it.

    @AH
    If its the mythical/mystical subluxation as a cure all then I agree with that article. If its for the musculoskeletal system as taught in universities to chiro’s and physio’s then please read these articles http://edzardernst.com/2016/02/catastrophic-outcome-of-chiropractic-spinal-manipulation/#comment-74566

    • “If its for the musculoskeletal system as taught in universities to chiro’s and physio’s” (As Frank Odds said, your use of apostrophes is hard to understand, as, I believe, is your logic.)

      This is an interesting ploy by chiros; transitioning from pretending to be “back specialists” to being “musculoskeletal specialists”. How much more are they going to commandeer from other professions in order to try to legitimise themselves? If this is the case, and as suggested before, why not abandon chiro, with all of its vitalistic baggage, and become a physiotherapist?

      • To join the Palaeolithic cult of Shake, Bake and Fake that is physiotherapy today, is a giant step backward for chiropractors, or in fact anybody with some semblance of knowledge of the neuro-musculo-skeletal system.

        • @ Camel,

          “To join the Palaeolithic cult of Shake, Bake and Fake that is physiotherapy today, is a giant step backward for chiropractors, or in fact anybody with some semblance of knowledge of the neuro-musculo-skeletal system.”

          Written by a true vitalist with a belief in the occult of the subluxation. Are you anti-vaxxer as well? Do you flog vitamins, use handheld clicky things, or is the clickety clack table thingy your preference?

  • Calling Dr Dave

    Whatever happened to Dr Dave (not a chiro or a medical doctor)? He was robustly defending chiropractic and now has vanished. Has he questioned whether chiro is worth defending?

    It is a pity a PhD molecular biologist did not stay in the field. It is an area that provides much hope for the ills afflicting humanity.

  • @Frank Collins
    Actually the shake, bake and fake cult within physiotherapy frustrates the physio’s reformers as well. Business as usual within physiotherapy as just as bad as business as usual within chiropractic. It is discussed on their forum SomaSimple. Similar issues to chiropractic! I am on that forum as well! Good discussions there!
    Is it chiropractic commandeering physiotherapy or physiotherapy commandeering chirropractic or both of us commandeering rehab from the Prague school and Stuart McGill in Canada? The lines are becoming increasingly blurred! To think that the traffic is all one way is simplistic! As we climb out of the rabbit hole some physio’s are diving in with zero external criticism!

  • All this talk about the Acupuncture awareness week makes me worried that we might forget all about the terrible consequences of neck wringing. I knew I had saved a link somewhere to a Youtube-potpourri of neck manipulations that made my own vertebral arteries hurt by just watching this extension-rotation frenzy. I stumbled over this link and here it is… twelve minutes or so of chiropractors and other neck wringers, doing their “thing”.
    It is not difficult to mentally visualise how at least once or twice a month, somewhere in the world, a vertebral artery gets overstretched by a slightly overzealous chiropractor or other enthusiast wanting to impress on his patient by producing a cracking sound. Not all of them will lead to tears but one person dead or injured is one too many when there is no evidence of this practice being beneficial for anything. Especially not as a preemtive measure in a cervically symptom free person. The chiropractor whom I saw for a while insisted I needed this kind of manhandling to prevent[sic] problems!!!
    When you watch this cavalcade of cervical cracking, keep in mind the illustration of how the vertebral arteries are tethered by the transverse processes of the cervical vertebrae and how they might be stretched by a rotating force on the top vertebrae.

    https://youtu.be/hV-wGiAn9nE

  • I am not in the medical field, my husband utilizes the services of a chiropractor when his neck or back give him issues and he gets immediate relief. When he initially went to a physician (MD) he was given drugs that never took care of the problem and left him rummy and unsafe at his job (running heavy equipment).

    In EVERY occupation, including the field of the healing arts there are GOOD and POOR practitioners. It’ time the medical profession comes together to work out guidelines and protocols crossing discipline lines as needed – instead of wasting time and energy belittling Chiropractics or acupuncture or eastern medicine.
    It wasn’t that long ago (110 years) MDs had minimal training – medicine has come a long way. SNOBS are useless.

    • @ Mleerose on Monday 21 March 2016 at 23:32,

      “I am not in the medical field”

      No, you’re not, however, without any consideration of the value of science, you believe you have an inherent right to make judgements you know nothing about. What do you do for a living, so anyone who may want might like to pass an opinion on your field (completely without any understanding of any of it, of course)?

      “In EVERY occupation, including the field of the healing arts there are GOOD and POOR practitioners.”

      Are there any other generalisations you would like to make (this one is a given)?

      “It’ time the medical profession comes together to work out guidelines and protocols crossing discipline lines as needed – instead of wasting time and energy belittling Chiropractics or acupuncture or eastern medicine.”

      No on is “belittling” anything; either a practice stands on its scientific validity or it doesn’t. Chiro is a crock, as is “eastern medicine”. When I go to see a doctor, as rarely as I can, I am happy to see an ‘eastern” doctor (mostly Chinese in Australia) because, generally, they are very good at “western” medicine. The quotation marks are there to indicate that medicine is medicine; “eastern” is not medicine.

      “It wasn’t that long ago (110 years) MDs had minimal training – medicine has come a long way.”:

      Yes, it has. That is because of science; something medicine has embraced and alt-med hasn’t. Where do you go if (when) you develop a cancer? Good luck, if it is to see a chiro or some “eastern medicine” flunky.

      “SNOBS are useless.”

      So are people who make stupid assessments without knowing anything about which they write. Are you anti-vax, do you believe in astrology, is the Earth flat, or was the Moon landing faked?

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