August 9, Simcoe, Ont. – Well known chiropractor and researcher Dr. Don Murphy has recently published a paper titled "Current understanding of the relationship between cervical manipulation and stroke: what does it mean for the chiropractic profession?"

The paper was accepted for publication on August 3, and appears in the journal Chiropractic and Osteopathy, 2010, 18: 22. 

The paper reviews the evolution of studies, to date, that have attempted to show causation between cervical manipulative therapy (CMT)  and vertebral artery dissection and stroke (VADS).  From these studies, the paper concludes that “…based on the best current evidence, it appears that there is no strong foundation for a causal relationship between  CMT and VADS”. 

The author goes on to say that a more probable reason that the two seem to be associated is that patients in whom a VADS has already been initiated will go see a chiropractor, or other manual therapist,  due to the headache and neck pain that are common symptoms of the dissection.  The incident will take its course, resulting in a stroke, independent of whether a manipulation is performed or not. 

The author then goes on to point out that there has been a shift, for chiropractors, from attempting to screen for patients who might be susceptible to VADS following CMT to enhancing their differential diagnosis with respect to VADS. He then outlines a natural history and profile for VADS and makes recommendations for when a DC might want to monitor the patient, and/or refer out for medical investigation.  

Murphy concludes with a discussion regarding how the profession of chiropractic – which has found itself linked to the VADS conversation – could adopt a public health leadership position and choose to become educators on the subject, given the knowledge that the profession has amassed and the lack of information widely available on this particular stroke disorder.  Chiropractors can become involved in providing valuable and necessary information regarding signs and symptoms of VADS, in order to educate patients and the public at large.