MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Spinal manipulation has regularly been associated with serious complications, most commonly strokes due to arterial dissections. But there are several other possibilities as well.

A new and unusual case report a serious complication after spinal manipulation has just been published:

A 54-year-old Indian gentleman, presented to hospital with exertional dyspnoea and chest heaviness for the past 6 months which had increased in the last 6 days. Dyspnoea increased on lying down. He was diagnosed as pneumonia on the basis of X-ray and chest CT scan, received treatment for the same and responded to the therapy.

However, breathlessness and hypercapnia persisted. He had unexplained hypercapnia for which extensive investigations were carried out. Neurological and cardiac assessments were essentially normal. On revisit clinical examination, he was found to have paradoxical diaphragmatic movement with respiration. Ultrasound of chest detected no diaphragmatic movement. Detailed history elicited that patient was fond of neck massage and neck cracking wherein his barber would bend his neck with jerk to either side after a haircut.

After considering all possible aetiologies, the authors concluded that this was a case of diaphragm palsy induced by barber neck manipulation, leading to Type-2 respiratory failure. The fact that the vital clues to the diagnosis were elicited by detailed history and thorough examination reinforces that history and clinical examination for doctors shall remain a very important tool for clinical diagnosis.

My chiropractor friends will be relieved, no doubt, to read that, in this incident, a barber rather than a chiropractor caused this unusual incident. Putting my tongue slightly in the direction of my cheek, the story shows me one thing: one does not necessarily have to be a graduate of a chiro-school to cause severe complications with neck manipulations. Occasionally, osteopaths, physiotherapists, doctors and even barbers are capable of the same feast.

21 Responses to Diaphragm palsy induced by spinal manipulation – a new case-report

  • And the barbers’ criteria for manipulation was NO better nor any different than a DCs. How much different would the outcome have been if the barber had done “motion-palpation”, leg length assessment or AK prior to the neck-assault….and charged an extra $45.00? How many DCs deliver neck-cracking to victims with NO real neck pain? Pretty damned often is the correct answer. A haircut is at least a value-proposition.
    The only other thing missing at that barber shop is a poster that says: “as the twig is bent so grows the tree”.

    • Fine sense of humor. I applaud, thank you!

    • “Please remember: if you make a claim in a comment, support it with evidence.”

      And the barbers’ criteria for manipulation was NO better nor any different than a DCs.

      How many DCs deliver neck-cracking to victims with NO real neck pain? Pretty damned often is the correct answer.

    • Hi Kenny,

      I have to admit you are persistent with wrong arguments that have no backing what so ever. We still don’t know what is your field of practice or training other than the fact you used to work with your ex –wife that happened to be a Chiropractor…

      well…my ex-wife is an engineer… that does not make me one… that does not mean all engineers are evil and when I get angry I go on the “ex from hell” blogs and not smearing engineers wherever I can find them… I wish you well

      • @FauxDrG: So you call yourself a “Chiropractor”….I would point out that also leaves onlookers to only guess as to what YOU do, and what your “field of practice is…” As none of you can ever give a straight answer as to what chiropractic is, or what you as a chiropractor does. Perhaps you’re smart enough to recognize NONE of “it” stands up to objective scrutiny by unsympathetic, erudite observers.
        I might also point out that an engineer is a REAL profession, an established, recognized endeavor who’s parameters and undertakings have been proven valid, reliable and withstanding of the utmost scientific and practical scrutiny….and having exceptional importance to all of mankind since the dawn of time. I’d suggest you rethink your analogy.

  • As a magician demonstrating The Magic of Alternative Medicine I show how a subject’s neck can be ‘cracked’ – by a gag plastic or metal cracker palmed in the hand. Or a plastic cup placed in the armpit and squashed!

    I am not saying that’s how chiropractors do it of course…

    Professor Riccardo
    Consultant Charlatan and Specialist in the Care of the Gullible

  • I listen to no criticism unless they have researched all of Dr. BJ Palmer’s work. I have debated many and mostly they are ignorant. All professions make errors of judgment and many are injured. Over a million have been permanently maimed by physician error over a 150,000 died from medicinal side effects in one year alone! Hades that’s not science- “side effects”a patented drug involved in studies killing people! Every damned drug has a conga line of side effects many of which are horrendous. I have gone through reading lists of side effects.
    And using the term placebo to explain away positive results when in reality this effect lasts on average about 45.7 days! About as long as we read in clinical hypnosis post hypnotic suggestions! You can’t use such a wayward argument. The result must last and the med must be discontinued. Nothing cures in medicine.

  • OK… I read the case report (Professor you send me chasing journals i didn’t know existed 🙂 … and I have to admit I found it quit lacking…

    1. I think the title should be “how did we miss-diagnosed a patient simply by not physically examining him”.

    2. I wrote to the doctor that published the case asking basic questions like how long did it passed since he last was manipulated? Is there any background of diabetes? Post polio? ALS? Lyme disease? How did they establish the connection to the Barber’s practice? Did they do any imaging of the cervical spine? … Unfortunately with no reply. We know most cases are iatrogenic, is that one of those cases? Is it not? I DON’T KNOW

    3. More interestingly this case highlights a problematic trend by young clinicians to put emphasis on lab and radiology rather than a careful questioning and through physical examination of the patient.

    • SORRY, when chiropractors start lecturing proper physicians, I find it hard to suppress a giggle.

    • or perhaps you are just a little envious because these guys got an article published – something you never managed?

      • and to the point? can you argue the science?

        • it was not a scientific observation – neither was yours!

          • This is a poor quality case report lacking basic details and clinical reasoning. If you have any comments as to the questions I raised I will be happy to discuss that.

            Also admitting they delayed diagnosis for not examining the patient properly is brave and deserves respect. And I THINK that is the main point to take from this… sorry if it does not fit anyone’s agenda or if I annoy anyone with legitimate clinical questions.

          • you are just trying to be cleaver by half; how often have you diagnosed diaphragm palsy?

  • How many times did you manipulate a cervical facet? It does not stop you from reading and writing about it does it?

  • And once again since you can not give a straight answer to a straight question you turn to personal comments…

    lets try one last time…
    is this case report of acceptable quality ?

    “the patient likes to get a haircut every 2-3 months” … does that amount to a causetive link according to your standards?

  • OK Professor I understand… I cannot recall when I avoided giving straight answers but never mind

  • This is what these barbers are doing. Their history and exam probably entail ‘how is the family?”

    https://youtu.be/iEihbpFFxDc

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