Expert: Scott F. Gillman, DC, DACBSP - 2/2/2007

Question
Even though you are probably right the following links coupled with what I was told by the physio is making me not go back to my chiropractor.This is what the physio was basing what he told me on and he told me to do a search on the net, I rather be wrong and not go to my chiropractor than go back and have the physio be proved right, I mean there are other treatments.

http://www.healthwatcher.net/chirowatch.com/cw-cervical.html

http://www.hfienberg.com/statstuff/chiro2.htm

http://www.ebm-first.com/?cat=5

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The text above is a follow-up to ...

-----Question-----
I have been seeing a chiropractor for the past week regarding a trapped nerve in my neck, I also have been seeing a physio theripist and what he had to say about chiropractors has got me worried.

He said the that manipulation of the neck is very bad for you and can cause brain tumors and brain damage over time.

He also said most chiropractors come from cananada and arent allowed practice there anymore, and that there have been quite a few horror stories relating to brain damage over there.

My chiropractor is registered under the chiropractic association of ireland, can you put my fear at ease?


-----Answer-----
Mark,  

What your physiotherapist said to you was so moronic that I can hardly believe he/she was serious.  Neck manipulation over time does not cause brain damage or brain tumors.  Canadian chiropractors are still in practice.  

While there have been tragic though rare incidents of strokes, paralysis, and other serious complications and injuries from JOINT MANIPULATION.  Some incidents occurred when applied wrongfully to the necks of people (i.e. by untrained practitioners), or applied to people that should not be receiving it (i.e. those with an underlying disease).  Many any of those accidents were at the hands of PHYSIOTHERAPISTS, and not chiropractors.  I would suggest you ask your therapist to put money on the table to prove his/her assertions before making ignorant, prejudicial, statements.  

Your chiropractor should also be able to put your fears at ease, but here are some things to know:

In a recent article on "Life Threatening Complications of Spinal Manipulation," by E. Ernst, MD, PhD, Dr. Ernst wrote: "Spinal manipulation has recently been associated with dissection of the vertebral and internal carotid artery, resulting in strokes and at least 1 death, hematoma, intracranial aneurysm, cauda equina syndrome, contusion of the spinal cord, myelopathy and radiculopathy, as well as palsy of the long thoracic nerve... complications are extreme rarities. Vis a vis the many thousand manipulations carried out daily, 200 or 300 complications in 5 years could be almost negligible..."    That's right, Mark, 300 complications over five years as compared to about 250,000 deaths per one year (USA) from prescription drug reactions.  How about 1:10,000 odds of death from a car crash?   There you have it.  Dr. Ernst has highlighted all the worst possible scenarios - quite rare - an in no comparison to the dangers posed by other healthcare methods.

Another interesting article on vertebral artery dissection following neck joint manipulation was performed in Germany:   Journal of Neurology; 2006, March; Vertebral artery dissections after chiropractic neck manipulation in Germany over three years.  The authors analyzed data from neurological departments at university hospitals in Germany over a three year period of time of subjects with vertebral artery dissections associated with neck manipulation.   They identified patients with vertebral artery dissection after what they called "CHIROTHERAPY."  36 patients were identified in 13 neurological departments.  Here's WHO they found to be the treating doctor/provider:
         
Orthopedic surgeon    n = 18 (50%)
Physiotherapist    n = 5 (14%)
Chiropractor       n = 4 (11%)
Gen. Practitioner    n = 2 (6%)
Neurologist       n = 1 (3%)
Homeopath       n = 1 (3%)
Unknown       n = 3 (9%)

What makes this interesting is that only 4 of 36 cases were performed by "chiropractors."  And, sadly, they called neck manipulation "chiropractic" or "chirotherapy" when in fact it was neck joint manipulation.  Also, it is possible that orthopedists' patients were under anesthesia during the neck manipulation.  This article was very misleading.  

Lastly, malpractice insurance costs for chiropractic healthcare is small in comparison to other professions. Here in the USA, I pay a fraction of what the MD pays.  In fact, my financial advisor pays more for his liability insurance than I pay for mine.  This, alone, highlights how safe this profession is compared to others.

Mark, chiropractic care has been deemed very safe.  Modern doctors of chiropractic are trained to know who to treat and how to treat to minimize the risks of accidents.  Doctors of chiropractic are part of the healthcare team in many respected venues, including professional sports teams and the Olympic Games.  The USA Olympic medical team has two DC among its 13 physicians.  Lastly, in survey studies on chiropractic patients, it showed that many are highly educated.  My patient base included MD's, PhD's, nurses, and dentists (for example).  I hope this puts your fears at ease.

Dr. G
www.drgillman.com      

Answer
Dear Sir,

You asked me for my professional opinion and advice and I gave it to you. It is correct and accurate.  Your physiotherapist is incorrect in his assertions.  If you want to get all worked up over sensationalized web sites, and wish to live your life fearful about the rare consequences and odds of a healthcare procedure, then that's up to you.  

Dr. G