Dr. Donald Murphy is Clinical Director of the Rhode Island Spine Center and a member of the Clinical Faculty at Brown University School of Medicine and the Postgraduate Faculty of 4 chiropractic schools.
Here’s his perspective on cervical manipulation, stroke, and what does it mean for the chiropractic profession.
An evolving relationship.
- In the beginning it was a simple cause-effect relationship, with chiropractic as the cause of vertebral artery dissection and stroke in certain susceptible individuals.
- It was considered extremely rare by chiropractic physicians, but far more common by neurologists and others.
The current view.
- Recent evidence indicates that the relationship is not causal.
- Patients with vertebral artery dissection and stroke often have initial symptoms that cause them to seek care from a chiropractic physician.
- Stroke is an independent event that occurs some time after chiropractic treatment.
The bottom line.
This focus has shifted for the chiropractic physician from attempting to “screen” for “risk of complication to manipulation” to recognizing the patient who may be having vertebral artery dissection and stroke so that early diagnosis and intervention can be pursued.
It’s an opportunity for the chiropractic profession to change the conversation about cervical manipulative therapy and vertebral artery dissection and stroke by taking a proactive, public health approach to this uncommon but potentially devastating disorder.
Dr. Murphy tells us, “The classic recommendation regarding the detection of signs and symptoms suggestive of VADS is the “5 Ds And 3 Ns”… (and 1 A)
- Diplopia (double vision)
- Drop attacks (seizure, feels as though the legs are giving way, with falling to the ground)
- Dysarthria (difficulty in articulating words)
- Dysphagia (difficult or painful swallowing)
- Ataxia (lack of coordination)
- Nystagmus (involuntary movements of the eyes)
More about patient screening and the public health aspects of this approach to risk assessment is discussed in the article.
Other views on this issue are summarized here.
8/5/10 15:24 JR