Stroke as a public health opportunity for chiropractic

Dr. Donald Murphy (photo) is Clinical Director of the Rhode Island Spine Center. He’s also on the clinical faculty at Brown University School of Medicine and the postgraduate faculty of 4 chiropractic schools.

Here’s his perspective on cervical manipulation, the risk of stroke, and what it means for the chiropractic profession.

An evolving relationship.

  • In the beginning it was a simple cause-effect relationship.
    • Chiropractic was considered the cause of vertebral artery dissection and stroke in 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 (ie manipulation on its own is not responsible for vertebral artery dissection).
    • Patients who experience 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.

For chiropractic physicians the focus has shifted from attempting to “screen” for “risk of a complication to manipulation” to recognizing patients 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)
  • Dizziness
  • 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)
  • Nausea
  • Numbness
  • 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

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.