MD, PhD, FMedSci, FSB, FRCP, FRCPEd

We have repeatedly discussed the risks of chiropractic spinal manipulation (see, for instance here, here and here). Some chiropractors seem to believe that using a hand-held manipulator, called ‘activator’, better controls the forces used on the spine and therefore is safer. This recent paper raises doubts on this hypothesis.

A neurosurgeon from Florida published the case-report of a 75-year-old active woman who presented to a local hospital emergency room with a 3-day history of the acute onset of severe left temporal headache, initially self-treated with non-steroidals, to which they were resistant. Additional complaints included some vague right eye blurring of vision and a mild speech disturbance. Her primary-care physician had ordered an outpatient MRI, which was interpreted as showing a small sub-acute left posterior temporal lobe haemorrhage. He then referred her to the emergency room where she was categorized as a “stroke alert” and evaluated according to the hospital “stroke-alert” protocol.

There was no prior history of migraine, but some mild treated hypertension. The patient subsequently gave a history of chronic neck and back pain, but no headache, for which she had intermittently received chiropractic adjustments. Her current problem started after an activator treatment to the base of the left side at the junction of the skull with the upper cervical spine. She became concerned enough a few days later, because of the persistence of unremitting headache, to contact her primary-care physician. The patient was not taking any anticoagulants or antiplatelet agents and had a relatively unremarkable past medical and surgical history. Although she did not have a formal visual field examination or an ophthalmology consultation, she was found to have an incomplete right homonymous hemi-anopsia on clinical exam by the neurologist.

Based on MRI characteristics, the haemorrhage was determined to be primarily subarachnoid and displacing but not involving any brain parenchyma, and without any extra-axial component. After a 4-day hospitalization for evaluation and observation, the patient was discharged, neurologically improved in terms of visual and speech symptoms as well as headache complaints, to outpatient follow-up. She has remained well with resolution of imaging abnormalities and no reoccurrence of symptoms.

The authors explain how difficult it is to prove specific causation in such cases. It is frequently inferred by epidemiological reasoning or evidence. While there are other potential causes of the haemorrhage that occurred in this case, none is as or more likely than the activator stimulus. In support of the activator as the cause of the haemorrhage, the symptoms began almost immediately after the activator treatment (a temporal relationship), the area to which the activator was applied is almost directly superficial to the area of haemorrhage (a spatial relationship), the anatomic location of this haemorrhage is statistically unusual for any underlying and/or preexisting conditions, including stroke. The MRI confirmed that there was no infarction underlying the area of haemorrhage. The MRA disclosed no dissections or vascular lesions present. The only mechanisms left are trauma or cryptic vascular lesion that ruptured, obliterated itself, and occurred coincident to the activator stimulus. Although Activator stimulus is not high energy, it nonetheless was targeted to the cervico-occipital junction, an area where neural tissue is among the most vulnerable and least protected and closest to the skin (as opposed to the lower cervical or any of the thoracic or lumbar spine). There are many articles that make reference to minor or trivial head injury as a likely cause of intracranial haemorrhage.

The author concluded that he was unable to find a single documented case in which a brain hemorrhage in any location was reported from activator treatment. As such, this case appears to represent the first well-documented and reported brain hemorrhage plausibly a consequence of activator treatment. In the absence of any relevant information in the chiropractic or medical literature regarding cerebral hemorrhage as a consequence of activator treatment, this case should be instructive to the clinician who is faced with a diagnostic dilemma and should not forget to inquire about activator treatment as a potential cause of this complication. Our case had a benign course, but we do not rule out a more serious or potentially dangerous clinical course or adverse outcome. This is of heightened concern in the elderly and/or those with treatment-induced coagulopathy or platelet inhibition.

In light of all of the difficulties inherent in linking chiropractic treatments, including activator treatments, with serious neurological events, it is very possible that intracranial hemorrhage is far more frequent than reported. Several articles comment on the likelihood that complications of this type are almost certainly underreported. Most of the incidents mentioned in case series or surveys had never been previously reported. Neurologists, neurosurgeons, and chiropractors should be more vigilant both in the application and evaluation of these methods in all patients who report new neurologic-type symptoms following a manipulation (including an activator application) to the occiput or the cranio-cervical junction.

I think that case-report speaks for itself.

Chiropractors will, of course, argue (yet again) that:

  • conventional treatments cause much more harm,
  • spinal manipulation is highly effective,
  • such complications are extreme rarities,
  • the risk/benefit profile of spinal manipulation is positive,
  • some studies have failed to show a risk of spinal manipulation,
  • case-reports cannot establish causality.

We have rehearsed these arguments ad nauseam on this blog. The bottom line is well-expressed in the above conclusions: it is very possible that intracranial hemorrhage is far more frequent than reported. And that obviously applies to all other types of complications after chiropractic treatments.

73 Responses to Cerebral Haemorrhage Following Chiropractic ‘Activator’ Treatment

  • A well noted case report on the association of chiropractic mechanical assisted manipulative therapy and its causal relationship with a intracranial lesion that fully resolved.
    According to the Australian Health Practitioner Regulation Agency , the risk of spinal manipulative therapy is real but rare.

    • “the risk of spinal manipulative therapy is real but rare”
      do you mean SMALL? a rare risk makes no sense to me.

      • I state “rare” which means highly infrequent.

        • risks are not infrequent, I think – harm is infrequent, risk is minor, small etc.
          English is not my mother tongue, so perhaps I am wrong; it’s just what I think.

          • To clarify, the risk of CVA injury due to spinal manipulative therapy is real but rare. That means permanant vascular/ neurological injury is highly infrequent. I appreciate your grasp of English as your second or third language. I speak three. American, Australian and Indonesian🤓

          • oh dear!
            are you unable or unwilling to learn?
            the risk is not rare but hopefully small [actually, we don’t know the size of the risk because there is no monitoring system in place].
            ‘permanent vascular injury’??? – why just permanent, transitory injury does not count in your book?
            ‘I speak three. American, Australian and Indonesian’ – I see!!!

          • No Prof,
            You aren’t wrong. Epstein is a chiro and has the usual thinking skills that entails.

        • The professor is correct.
          An event or condition can be ‘rare’. It can of course also be ‘frequent’. The term risk however denotes the probability of an event occurring, which can be ‘high’ or ‘low’ or anywhere in between.
          Risk is estimated by measuring or approximating the rate of events in a given population of subjects.
          Saying that a risk is “rare” may indicate a lack of formal knowledge and understanding of the scientific principles.

    • Definitely small–> large in risk. Not rare—> common.

      Put it this way, if the risk of developing something is small (say 5%) it is 5% each time. If you do it once or a thousand times it is always 5%.

      So saying that the risk is rare does not make sense. Saying that the occurrence is rare based on the small risk would make sense.

      But saying that spinal manip Rx is a rare risk factor for stroke does make sense. This is because of all the risk factors for stroke, this is a rare one. You just cannot say it the other way around.

  • Edzard Ernst: I think that case-report speaks for itself.

    Well, I’m not so sure it does… or at least, I’m not so sure what the case report says or is saying, if anything. For one thing, we’re talking about a cerebral hemorrhage that supposedly followed a chiropractic ’Activator’ treatment. While it’s not super critical to know whether or not the chiropractor was using the diagnostically and therapeutically arbitrary Activator Methods algorithm to treat or just using the “Activator” instrument to effect “Thuh” Adjustment, unless the chiropractor was leaning mightily with his or her full weight on the tool while clicking or hitting its end with a heavy hammer like they were sculpting a marble bust, I have very serious doubts that a “click” from an Activator device could even bruise the skin, never mind transmit enough force through the skin and underlying tissue to do anything of consequence, positively OR negatively. In fact, I had the camera crew of Adjusting the Joints in stitches clicking randomly all over my neck after filming my part in the production of A Different Way to Heal?.

    If you haven’t watched this video, I encourage you to do so … if ONLY to see Activator Methods diagnostics and therapy “in action.” But, there’s so much more to see and learn — better than a free ticket to Ripley’s, Believe it or not. When the producers called me to do this, I told them the best approach to quickly bursting a chiropractic bubble was to go to my alma mater, turn their cameras on, and film the chiropractors telling you –in their own words— what they are thinking and doing and why. Nothing better than getting directly from the horse’s, er … mouth.

    Given limited time, I suggested a full-spine Technic,” a “reflex” Technic, and an “Upper Cervical” Technic. Representing one of the possible chirodigms in each of these categories was a Gonstead, Activator Methods, and Toggle Recoil chiropractor, respectively. For the “Upper Cervical” example, I had recommended they get a NUCCA (National Upper Cervical Chiropractic Association) practitioner, but I guess no NUCCA teacher was on campus that day. Too bad, too, because it’s really the “homeopathy” of “chiropractic.” In fact, Johanna Hoeller, a practitioner of this chirodigm, supposedly didn’t even touch the patient when delivering “Thuh” Adjustment. (FYI: No-Touch Chiropractic

    I mention all this because I discouraged the producers from including stuff about vertebral artery dissection and stroke. I knew that they couldn’t resist because of the drama — and of course, they did include it — but I had hoped, since the question being asked was, “Is ‘chiropractic’ a different way to heal?,” that the focus would be on what was so diagnostically and therapeutically arbitrary about The Chiropractic Enterprise altogether. All therapies have potential unintended effects. By arguing that stroke rarely and barely ever occurs, like one in a million (a chiropractor might argue), already you’ve forgotten how stupid their spinal fetishism and quackery are. I mean, is there really something to all that “chiropractic?”

    For example, and getting back to the subject of this thread, you’re in danger of arguing about whether or not an Activator tool can cause a cerebral hemorrhage rather than the imbecilic and empty efforts of a chiropractor using one to deliver a Chiropractic Adjustment by clicking in places The Body “tells” them to based on algorithmic “challenges” and The Body’s “feedback” confirmed by “leg-checks.” I’d SAY, “You simply can’t make it up this good,” but apparently, you CAN. I realize, most of you think leaving out “the stroke part” might not be the most effective quack-busting approach, because, like the producers, “death at the hands of a chiropractor” makes for a better headline. But, I submit that scaring people with a “Don’t see a chiropractor because they could kill or disable you” is not among the best reasons for avoiding any one or all of them — at least without first considering any benefit you might get — and especially the advertised benefits of “chiropractic” that you will NOT receive.

    Let me put it this way … supposing there was zero risk to see the practitioner cited in the case report above? What are you left with then, if not a bunch of chiropractic egg on your face? 🙂

    Anyways, make yourself a bowl of popcorn and watch the video. Then get back to me. There’s more there than you might realize. Even for the sake of the discussion here related to stroke and cerebral hemorrhage, for example, Doctor Browning — the Activator Practitioner featured — inadvertently argues that he’s doing the same thing as all those chiropractors who crack joints. WHAT is he doing? And, if the Activator IS safer with regards adverse effects — especially the potential for stroke — why don’t all chiropractors do Activator to “Adjust?” It’s not one chirodigm is “good” for this and another “good” for that. It’s important to realize that each chiropractor featured in this 2002 film treats each patient with the chirodigm they demonstrate no matter what the entering complaint. That was the point of me “checking the legs” at the beginning of the video after the patient tells me his head hurts. What. Isn’t “checking the legs” the first thing any of YOU doctors do when you see your patients? You can’t BE too careful, you know 🙂

    ~TEO.

  • Anyone who has seen an Activator and clicked the useless device on his own palm(or anywhere, for that matter) would know that it is no more likely to have caused a sub-arachnoid bleed than tapping a person’s skull with the eraser of a pencil. The Activator does not even cause joint cavitation thus is really not an instrument of manipulation as such is typically defined. I doubt that the “pop gun” would even cause much, if any, bruising if applied to a bony prominence of a 90 year old who was using Warfarin.

    Having stated the above, it is suspicious that the area of the lesion appeared to be temporally and spatially related. This case report was well written and informative.

  • Just goes to show ignorance is a bigger cause of death than the Activator will ever be. Although I haven’t got an RCT to back it up this statement so i must be a quack! http://www.bmj.com/content/327/7429/1459

    • Thumbs up! Hilarious post and link!

    • Some realities do not require RCT’s or would be unethical, impossible to perform. Chiropractic manipulation of alleged subluxations is illogical, nonsensical and does not even have logical biologic explanations, other than stretching and massaging soft tissues. Double blind studies are critical in some situations but not even necessary for manipulations since, like your parachute scenario, common sense tells us to use a parachute and avoid cracking necks.

      • In my experience common sense is not that common. Ignorance more so. Can you define your understanding of ‘subluxation’?

        • Can you define your understanding of ‘parachute’? Most especially, your understanding of the parachutes that have been cured of their subluxations 🙂

          Thank you for the link to that superb BMJ article.

        • @Rachel on Sunday 29 January 2017 at 16:44

          “In my experience common sense is not that common. Ignorance more so.”

          Especially among alt-meds (including chiros, of course).

          “Can you define your understanding of ‘subluxation’?”

          As chiros coined and use the term, yet have never identified one on X-ray or any other means, it seems pointless to define something which does not exist.

          • Rachel asked: Can you define your understanding of ‘subluxation?

            Sure. A Chiropractic Subluxation is whatever a chiropractor chooses to define as a problem.

            The Chiropractic Subluxation is a uniquely chiropractic diagnosis that almost always, but not necessarily, refers to something the chiropractor believes to be “wrong” or “bad” with the Chiropractic Spine. It’s treated with a Chiropractic Adjustment — another umbrella term loosely referencing a chiropractic “treatment” which almost always, but not necessarily, involves joint popping directed at “fixing” what’s been arbitrarily determined by the chiropractor to BE the Chiropractic Subluxation. This is what’s called touching your own Chiropractic Nose.

            ADJUSTING THE JOINTS

            ~TEO.

          • Abnormal spinal motion is well documented to cause local and central neurological changes?! If you wish to inform yourself what what science is telling us then take the time to listen to this http://chiropracticscience.com/podcast/drheidihaavik/

            I am amazed at how many critics of chiropractic seem to think chiropractors today hold onto the outdated concept of a subluxation. They seem ignorant of what new research is telling us and are seemingly themselves stuck in the past.

          • Rachel said:

            take the time to listen to this

            Seriously? An interview? Why not just link to the evidence to back up the claims you make?

  • For those with a serious aversion to an interview with a professor of human neurophysiology…

    http://www.chiropracticscience.com/podcast/drheidihaavik/

    Here’s a link to her research…

    https://www.researchgate.net/profile/Heidi_Haavik/publications

    • @ Rachel

      Slide 5 here http://www.slideshare.net/heidihaavik/dr-heidi-haavik-melbourne-presentation says that Heidi Haavik’s mission is to “run a ridiculously successful and Vitalistic International Centre for Chiropractic Research”.

      I think that disqualifies her from being taken seriously.

      • I thought guys critique the research?! When someone does the research you disregard it because it doesn’t fit into your world view! I thought the role of pharmaceutical companies was to make a ridiculous amount of money?! There’s nothing wrong with aiming to be successful at what you do!

        • @ Rachel

          How can Heidi Haavik be successful and be respected by the scientific community when she’s flogging a dead horse? IOW, vitalism is a bogus notion. See here:
          https://sciencebasedmedicine.org/the-death-and-rebirth-of-vitalism/

          • You seem to be deflecting the issue.

            This is the link to her research again https://www.researchgate.net/profile/Heidi_Haavik/publications

            You have not given me a link to any research – this is someones opinion & they are ignorant.

            As quoted from your link:
            “Chiropractic uses the concept of “vertebral subluxation complexes” that block the flow of vital energy, despite the lack of any evidence for these things.”

            This show ignorance on behalf of the author as this is an outdated concept. I know of no chiropractors who keep up to date with current research who holds onto the outdated concept of a vertebral subluxation (i.e. bone on nerve).

            Again I point you to her research to understand how spinal manipulation has a neurophysiological effect.

          • @Rachel

            Heidi Haavik said; (see link from Blue Wode)

            Heidi Haavik’s mission is to “run a ridiculously successful and Vitalistic International Centre for Chiropractic Research”.

            You said

            “Chiropractic uses the concept of “vertebral subluxation complexes” that block the flow of vital energy, despite the lack of any evidence for these things.”

            This show [sic] ignorance on behalf of the author as this is an outdated concept.

            Blue Wode said:

            I think that disqualifies her from being taken seriously.

            Get it now??

        • @Rachel

          “I thought guys critique the research?” I admit I’m a guy, but the same doesn’t necessarily apply to all commenters on this blog, many of who use pseudonyms.

          Yes, my interest is mainly in the research, but Blue Wode’s quote about Heidi Haavik’s mission says she wants to run …”a Vitalistic International Centre…” Vitalism is a concept that was discredited ages ago. The quote speaks volumes.

          Just out of curiosity I followed your link to Haavik’s research. From 2014 to 2016 she published 12 papers in peer-reviewed journals, of which five were in specialist chiropractic journals with low impact factors. She does two types of research; mostly neurophysiological work detecting electrical neurological responses to various stimuli (sometimes including spinal manipulation) and pilot clinical trials of chiropractic. The latter would score largely negative points on Edzard Ernst’s recently suggested list of criteria for good research. Only three of these Haavik publications have been widely cited in other publications (5, 8 and 10 times), the majority have no citations.

          • If you listen to her interview you would know that Haavik specifically research’s into how an adjustment works – the mechanism – which is different from clinical research which is looking at the efficacy of a treatment for a certain condition. Are you suggesting that a spinal manipulation has no neurophysiological effect? If so where is your evidence?

          • @ Rachel

            I remain totally unconvinced. It looks suspiciously like Heidi Haavik employs the Chiropractic Method of Investigation.* For example:

            “The Science of Chiropractic – General introductory session that will cover…ways in which science can bolster chiropractic practice…what evidence we need…There will be an attempt to “make it real”… This session is also aimed at increasing the awareness and understanding of the more dominant mechanistic health paradigm that many health professionals are likely to have and how best to respectfully communicate our vitalistic chiropractic point of view to and with them.”

            Ref: http://www.sca-chiropractic.org/files/Heidi%20Haavik%20Seminar%20April%202012.pdf

            *The Chiropractic Method of Investigation is outlined here:
            https://jdc325.wordpress.com/2009/05/08/chiropractic-and-the-bca-research-page/#comment-3372

          • @Rachel

            I don’t doubt that if you manipulate a person’s spine you can electrically measure a neurophysiological change elsewhere in the body. That’s unremarkable. But when you say this kind of experimentation shows how an adjustment works… The important question to answer first is whether an adjustment works; and how you define ‘works’. The clinical evidence for spinal adjustment achieving anything beyond placebo effects is seriously unconvincing. That means there’s really no mechanism to explain.

          • if someone falls down the staircase, there would also be a lot of measurable effects. this does not mean that falling down the staircase is a good therapy for anything.

          • Rachel,

            If a fly lands on you, or on your food — and you notice it — that fly will induce in you a profound neurological and chemical response that is very easy to measure using a plethora of 21st-century instrumentation, including: ECG; EEG; MRI; and analysis of your blood chemistry.

            I hope that you can begin to grasp the abject absurdity of using such measures to endorse the effect, let alone the efficacy, of chiropractic or any other form of vitalistic charlatanism/shamanism.

          • That’s why you measure WHERE in the brain responses are elicited & understand the importance of those areas.

  • You remain unconvinced because you want to. Rather than quoting a few slides from a conference that you weren’t present at , having suspicions and attacking the author, why not critique what the research showed! I think its dangerous to attack validity of research purely based on the authors’ faith, values, world view, behaviour etc. – critique their outcomes. Are you suggesting you would think less of a pre-eminent scientists’ research because, for example, they had a belief in the existence of a higher being, which you thought to be completely ridiculous & non-scientiific (I’m not assuming you do hold this view).

    ;-P

    The highest form of ignorance is when you reject something you don’t know anything about.
    Wayne Dyer

    Real knowledge is to know the extent of one’s ignorance.
    Confucius

    Ignorance is always afraid of change.
    Jawaharlal Nehru

    Ignorance never settles a question.
    Benjamin Disraeli

    The recipe for perpetual ignorance is: Be satisfied with your opinions and content with your knowledge.
    Elbert Hubbard

    Opinion is the medium between knowledge and ignorance.
    Plato

    There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance.
    Hippocrates

    • @ Rachel

      There’s also this one:

      It is difficult to get a man to understand something, when his salary depends upon his not understanding it.
      Upton Sinclair

    • @Rachel on Friday 03 February 2017 at 12:38

      “You remain unconvinced because you want to.”

      No, because she is a vitalist and subluxationist, which many other chiros have disowned because both are nonsense. If she can show evidence of a subluxation, it will be a world first.

      “Rather than quoting a few slides from a conference that you weren’t present at , having suspicions and attacking the author, why not critique what the research showed!”

      Those few slides are enough to discredit her entirely. What difference would being there to see the nonsense have at all?

      “I think its dangerous to attack validity of research purely based on the authors’ faith, values, world view, behaviour etc. – critique their outcomes.”

      Because those views shape what she wants to believe, and any “research” is to reinforce those beliefs.

      “Are you suggesting you would think less of a pre-eminent scientists’ research because, for example, they had a belief in the existence of a higher being, which you thought to be completely ridiculous & non-scientiific (I’m not assuming you do hold this view).”

      I do think less of a scientist (in fact, anyone) should they believe in some celestial fairy. It shows they have decided what to believe and mould everything else to fit. It is ridiculous and unscientific. Lord Russell illustrated the silliness of belief with the Celestial Teapot.

      • “If she can show evidence of a subluxation, it will be a world first.”

        Let be briefly summarise what we do know:

        Segmental restrictions of movement and static and/or dynamic facet joint dysfunction are known to commonly occur. Restricted joint mobility results in decreased firing of mechanoreceptors and increased firing of nociceptive axons. Segmental restrictions are know to cause an increase in blood flow after only 1 day and increased collagen formation after 3 days, ultimately leading to damage of the subchondral bone. Chronic decreased range of motion leads to increased nociceptive and decreased proprioceptive afferent input into the central nervous system. Decreased mechanoreceptive input result in less inhibition of nociception and to decreased essential afferent input into the cerebellar-brainstem-cortical loops. Spinal manipulation restores range of motion allowing improvement in facet joint mobility & affects afferent neurological input by increasing/restoring mechanoreceptive input and decreasing nociceptive input.

        Cervicogenic headaches are a well established diagnosis.

        “The suboccipital nerve (dorsal ramus of C1) innervates the atlanto-occipital (AO)joint and dura matter over in the posterior fossa. Therefore, a pathologic condition of AO joint is a potential source for occipital headache.”

        “The trigeminocervical nucleus is a region of the upper cervical spinal cord where sensory nerve fibres in the descending tract of the trigeminal nerve (trigeminal nucleus caudalis) are believed to interact with sensory fibres from the upper cervical roots. This functional convergence of upper cervical and trigeminal sensory pathway sallows the bidirectional referral of painful sensations between the neck and trigeminal sensory receptive fields of the face and head.”

        BTW – “I do think less of a scientist (in fact, anyone) should they believe in some celestial fairy.”

        Science cannot account for everything. Thankfully & respectfully, most people do not hold your narrow thought patterns.

        • @ Rachel

          Is it really worth pursuing this ‘debate’? IOW, after c. 120 years, the robust data that are in for chiropractic spinal manipulation show it to have a slight pain relieving effect for low back pain sufferers *only*, and even then it is no better than sham or cheaper and safer options (e.g. exercise). What’s more, the World Health Organisation takes a dim view of it:
          http://www.ebm-first.com/chiropractic/various-concerns/1848-world-health-organisation-who-says-that-the-consequences-of-the-chiropractic-subluxation-are-hypothesized.html

        • Rachel, you challenge us to criticize the evidence, so I’ve taken the time to look at the first three most recent (and peer-reviewed) publications in the link you gave us. Here are the notes I made.

          Brain Sci. 2017, 7, 2; DOI:10.3390/brainsci7010002. Shows spinal manipulation results in detectable electrical changes in motor an upper limb muscle. Unremarkable result, poor control group (passive head movement vs. spinal manipulation).

          Frontiers in Human Neuroscience 2016, 10, DOI: 10.3389/fnhum.2016.00482. Shows that flexing the ankle gives detectable electrical changes in the cortex. Unremarkable (confirmatory) result. Sound neutroscience. (See also comment from Pete Attkins in this thread.)

          Journal of Manipulative and Physiological Therapeutics, 2016, DOI: 10.1016/j.jmpt.2016.04.004. Pilot clinical trial of effects on pelvic floor muscles of spinal manipulation in pregnant females. Measurement of effects by perineal ultrasonography. Dreadful study. Controls were nonpregnant women, significantly younger than the pregnant group (p<0.001, but the authors don’t mention this self-critically, merely stating the age ranges of the two groups. Status of pelvic floor muscles in nonpregnant women, mean age 23, is certain to differ from that of pregnant females, mean age 31. Meaningless study.

          Worst of all are the criteria for spinal manipulation: “The clinical indicators…used to assess the function of the before and after each spinal manipulation intervention included assessing for tenderness to palpation of the relevant joints, manually palpating for restricted intersegmental range of motion, assessing for palpable asymmetric intervertebral muscle tension, and any abnormal or blocked joint play and end-feel of the joints. All of these biomechanical characteristics are known clinical indicators of spinal dysfunction [7 references cited]. Areas of dysfunction were then manipulated as clinically indicated.” Nowhere is there any statement that a subject was rejected from the study because no spinal dysfunction was found. This is classical chiropractic gobbledygook in which everyone has some degree of spinal dysfunction that requires chiropractic attention. Although the term ‘subluxation’ never appears, ‘spinal dysfunction’ is pretty clearly the present-day equivalent.

          I remain unimpressed.

        • @Rachel on Saturday 04 February 2017 at 13:02

          “Science cannot account for everything. Thankfully & respectfully, most people do not hold your narrow thought patterns.”

          Well, we got to the crux of it. You have decided what you want to believe, as do the religious, and then mold everything to fit that view; cognitive dissonance at its “finest”. You’ve ignored everything else I, and everyone else, has said and ploughed on regardless. To you, it would not matter what evidence destroyed chiro, you will believe in it, just as you do with some celestial fairy. Research Russell’s teapot; it fits you to a “T”.

          • @Frank Collins on Sunday 05 February 2017 at 23:15

            “Research Russell’s teapot”

            At what point have I asked you to prove a universal negative?

            “You’ve ignored everything else I, and everyone else, has said and ploughed on regardless.”

            ?? I thought it was called having a discussion & respectful disagreeing. That doesn’t mean I have ignored it

          • @Rachel on Tuesday 07 February 2017 at 11:39

            “At what point have I asked you to prove a universal negative?”

            It is about the Onus of Proof, part of which is requiring the proof of a negative. Russell claimed the existence of an orbiting teapot which he said could not be disproved. You, and others, claim that chiro is efficacious and demand others to disprove it.

            Well, after 121 years and numerous studies and RCTs, there is still no evidence of chiro being efficacious. In any risk/benefit consideration, chiro has risks and no evidence of benefits, putting aside anecdotes which have been similarly provided for every version of CAM, including drinking snake’s blood. In the absence of evidence, we can dismiss chiro as a fraud, just as it was when invented by Palmer, the convicted crook.

            As Hitchens said, “That which is claimed without evidence, can be dismissed without evidence”.

  • I just received this email [not sure whether it related to this or another post]:
    I cannot believe what I just read.  What kind of despicable person are you that would try to scare the hell out of the public by writing without any conscience to truth or fact (by the way you worded your “facts” to sell to the unsuspecting public that chiropractic is more dangerous then medicine or MD’s or DO’ or PT’s  or the 144,000 reported hospital deaths due to errors!  Really??
    I had to write and say that it is truly one of the most ridiculous articals I have read in a long time that has so lied and try to mislead the public about a profession that has saved countless lives after medicine failed or killed the patient before we (yes, I am a DC) could save them.
    Your in health
    J. Gurman, DC

    • Oh dear, if this is the same chiro as Jett Gurman in Westwood, New Jersey, he’s also an acupuncturist, two thirds of the quack trifecta. Homeopathy would round out the trio. He proudly performs his chiro on newborns AND he believes in subluxations.

      Extracted from his website (with all the errors and Needless Capitalization intact):

      “… Dr. Jett Gurman … remained and continue to grow as one of the most successful practices in Bergen county. Patients range from newborns to 91 in age… Chiropractic Prenatal and postnatal Pregnancy care is one of our specialties as is Chiropractic Pediatrics and Chiropractic Geriatrics …
      We provide Chiropractic care and Acupuncture … Once we review findings and it is determined that spinal misalignment is resulting in abnormal function and nerve pressure (AKA Spinal Subluxations) and thus at cause of the health challenge, patients will return and findings reviewed with the patient and only after that review and the patient understands the problem and what is needed to correct it will they be provided with Specific Chiropractic Spinal Adjustment techniques to specifically, genitally, and safely provide care to restore proper spinal alignment and aid in recovery of neural (nervous system) integrity. This process allows for improved health and wellness as well as a reduction in, often times, painful symptoms. For severe or chronic type we have the services of a licensed acupuncturist that, when needed, works with us rather then having to deal with the dangers of OTC drugs or other medications that do not address the underlying cause often but only mask symptoms and often create other health issues and crisis.”

      What a dumbass.

    • @ edzard on Tuesday 07 February 2017 at 19:53

      Is it this bonehead who can’t spell or write properly; Jack Gurman, proprietor of the Northcote Chiro Centre here in Melbourne, Australia? http://www.northcotechiropractic.com/chiropractors.php

      He is a subluxationist; http://www.northcotechiropractic.com/newsdetails.php?id=5

      Also sells a herbal pain relief cream; http://www.northcotechiropractic.com/shop.php
      http://www.fisiocrem.com/australia/what-is-fisiocrem/

    • Prof Ernst
      if this email by Jack Gurman was sent to you privately, and not in a blog, did you get permission from him to publish it? If not, why not? At present it appears to be private correspondence between him and you, It may not have been intended for it to put into the public area. At present, your publication allows trolls (Read “The two Franks), to harass him. Where are your ethics?

      • you think that I should protect people who harass me from harassment?
        are you quite there?

        • Prof Ernst. I think it is unethical for you to release into the public arena an email that was sent to you privately, without getting the permission from the person who sent it.

          • good for you to have such high ethical standards; pity that the author of this ad hominem attack does not share them. personally, I have no problem sharing the insults that come my way with the public.

      • @GibleyGibley on Thursday 09 February 2017 at 01:33

        You think you can question someone, anyone, about ethics? You are a chiro, remember.
        When are you going to post your website URL so we can see what bizarre stuff you engage in?

        “are you quite there?”

        Rhetorical question, of course.

  • Frank. What under-graduate or post-graduate qualifications do you have in medical ethics or ethics in general?

    • @GibleyGibley on Thursday 09 February 2017 at 22:00

      Why? I could ask you the same question, except I know you don’t have any proper qualifications.

      I repeat;
      “When are you going to post your website URL so we can see in what bizarre stuff you engage?” (Grammar corrected)

      No more Red Herrings, no more excuses, no more deflections, no more Strawmen, tell us what you do. I know you won’t because you will get a savaging for the nonsense everyone will see.

  • Just in case you didn’t think it was possible to take a Chiropractic Subluxation Joke too far:

    Network Spinal Analysis Care – Demonstration of Level 1

    Indeed, the deepest levels of the Chiropractic Void and Chiropractic Id are all about the Removal of Nerve Interference. The chiropractor removes whatever is obstructing Chiropractic Nerve “flow.” The most primitive notion of an obstruction is a “bone out of place,” otherwise known as a “vertebral misalignment.” That’s one reason why you see chiropractors cracking the Chiropractic Spine every which way — to remove the “obstruction”… as they see it, that is.

    Sure, you have some Joint-Dysfunctionalists who claim they aren’t Subluxationists because they don’t use the term, “Subluxation.” And yes, for a very few of them, that means they’ve entered the physiotherapeutic mobilization zone, which isn’t all that bad I suppose, since a back-crack does sometimes seem to help some people with some complaints some of the time. And, to be sure, joint popping makes for a pretty cool parlor trick.

    But “joint popping” does not a doctor nor medicine make, except it you’re a chiropractor, it seems. And frankly, without specifying a diagnosis beyond “something wrong with your joint function,” I’m afraid even the Joint-Dysfunctionalist is talking about the same-old, same-old “chiropractic … as in, “Adjust the spine and all is fine.” This is especially true if you hum this same chiropractic spinal tune whenever you see a patient.

    “Let me check your Spine,” said the chiropractor.

    Oh — I forgot to bring it all back home to a hemorrhage possibly caused by an Activator Instrument. While I’m skeptical as to how an Activator “instrument” can cause a stroke by itself, the real issue is adverse effects incurred as a result of providing quack and/or empty therapies. In other words, when the Chiropractic Goal is to Remove Nerve Interference, Restore Energy Balance, or fix any of the panoply of Chiropractic Subluxation fictions, the adverse effect just adds chiropractic “insult” to the original chiropractic injury, which is its quackery.

    ~TEO.

  • An activator is such a gentle tool. Used on a lower setting for cervical use it is barely going to cause problems.

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