Is Cervical Manipulation Safe?

Following the tragic, untimely death of Instagram star Katie May, I have received a lot of questions from my patients here at Hemmett Health about the

safety of cervical manipulation (neck adjustments). If you haven’t heard the whole story, here it is in a nutshell: Katie May spent and afternoon at a photo shoot, and suffered a bad fall. She later remarked via Twitter (social media speak) that she had “pinched a nerve” in her neck, and was headed to the chiropractor. A couple days and two chiropractic visits later,    Katie suffered a stroke and passed away. She was 34 years old.

The media has been a frenzy of accusation and confusion about whether or not her chiropractic treatment contributed to or could possibly have caused her death. The American Heart Association, the American Chiropractic Association, neurosurgeons, chiropractors and a plethora of online bloggers have had a lot to say about this. Stroke caused by neck adjustments is not a new allegation, not is it unwarranted. There are stories of this same situation playing out through chiropractic history. Before you go goggle crazy and cancel all your appointments, let me explain the anatomy and physiology of what happens in these heartbreaking cases.

The Vertebral Artery (VA) is a nerve in your neck that brings blood to the brain. It runs at a perpendicular angle relative to your spine, which, as you can see in the picture below, puts an atypical stress on the artery when you rotate your head. Your artery is well equipped to tolerate this rotation, after all, it’s how you were designed. Unless, it isn’t… what I mean by that is, if you have a tear in that artery, called a dissection, or there is a problem with the inherit structure of your artery, then that rotational movement would be harmful.

In Katie’s case, she had a dissection of her VA artery. It is plausible that she sustained this dissection during her photo shoot when she had to hold her head in an awkward position for a prolonged period. She did not “pinch a nerve” at that time. When she then had her neck adjusted, it further damaged that injured arty, and produced a blood clot, and eventual stroke.

Did the chiropractor cause Katie’s stroke? Absolutely not. Did her adjustment cause an injury to an otherwise healthy artery? Not a chance. Did the rotational force of the adjustment worsen a pre-existing problem, exacerbating the condition? It sure did.

The signs and symptoms of a VA dissection are very similar to those that bring most of us to the chiropractor or doctor: neck pain, tension, and headaches. Unfortunately, there are no tried and true tests to be performed to evaluate for a dissection without having an angiogram- a very expensive test visualizing arteries, that is not feasible for every neck pain patient.

From the American Chiropractic Association: “Millions of neck manipulations are performed safely in the U.S. every year, providing patients relief from common forms of neck pain and headache, and helping them to get back to their normal activities. The best available evidence today indicates there is no causal relationship between neck manipulation and stroke. Instead, the evidence suggests that those experiencing symptoms of a stroke in progress, such as severe headache and/or neck pain, may visit a chiropractor or a medical doctor for treatment”.

So, as a doctor, what do we do? We take excellent, detailed histories of your condition, your medical past, and your families medical history. We watch for the major “red flags” that would indicate to us that there is a change from your normal symptoms, suggesting a change in your health.

And as a patient, what do you do? Give a clear, thorough and honest history. Tell your doctors about any blood disorders or collagen disorders that run in your family. Be detailed in your descriptions of history, and always tell your chiropractor if your symptoms feel different than they have in the past.

Katie’s death was nothing short of a tragedy, and our hearts go out to her family. Although reviewing the clinical details of her exceedingly rare case that caused her death will of course bring no comfort to their grief, I hope we can bring reassurance to you, our readers, our patients.

The Hemmett Health Team, written by Dr. Brooke Calhoun