there's nothing quite like thesatisfying crack your back emits with a chiropractic adjustment. If the noise is coming from your neck, though, beware -- more than just a vertebra or two might be loosening up.
For some chiropractic patients, adjustments can cause fatigue or discomfort, but most of this fades away within 24 hours.
Chiropractic neck adjustment, on the other hand, increases the risk of stroke. Arteries that run up the back of the neck kink just before entering the skull, making their inner linings vulnerable to being torn by head rotation. This injury is called arterial dissection. If a tear occurs, a clot forms over it. And if the clot comes loose and enters the brain, a stroke occurs.
There are also six documented cases of chiropractic neck manipulation damaging the phrenic nerves, resulting in paralysis of the diaphragm.
This has sparked a vigorous debate between Canada's chiropractic and allopathic communities about the risk of stroke. Chiropractors claim the risk is one per million adjustments. (About 45 million adjustments to all areas of the back take place annually in Canada.)
Chiropractic's critics charge that the real number is somewhere between one stroke per 3,000 to 15,000 patients -- and they argue that, given the risk and the fact that research shows so little benefit from neck adjustments, the procedure is never justified.
A recently published Ontario study found that people under 45 who had a stroke due to arterial dissection were five times more likely to have visited a chiropractor for a neck problem in the week prior to the stroke than the members of a control group.
To put things in perspective, though, keep in mind that playing golf or turning your head while driving can also cause dissection.
An ethical chiropractor will inform you of the risks. You should avoid neck adjustments if you take the pill, use blood thinners or have high blood pressure. Never get an adjustment if you've recently suffered severe neck pain -- that's one possible symptom of arterial dissection.
If chiropractic care suddenly makes you jittery, you can lower your risk by working with a physiotherapist who adheres to orthopractic standards. Or try Network Spinal Analysis, a kind of chiropractic that doesn't use twists or thrusts.
"A traditional chiropractor palpates for areas of tension in the spine and releases them. What we do is a series of gentle contacts, and that's it."
Lynne McRoberts Chiropractor and Network practitioner
"We were surprised to find out how many strokes were caused by chiropractic manipulations -- about 20 per cent of those caused by arterial dissection. In Canada, between 100 and 200 strokes are caused by chiropractic dissections per year."
John Norris Neurologist, University of Toronto
"Chiropractic is one of the safest forms of health care. The critical issue is the diagnostic process of determining who is vulnerable to these occurrences. The Ontario study is inconclusive as to whether chiropractic was the cause of the strokes."
Chiropractor and secretary-treasurer, Canadian Chiropractic Association
"Canadian physiotherapists don't endorse rotational manipulation of the neck at all."
Jeffery Garrett Physical therapist