Dear Dr. Strauss
If a practice member, for whatever reason decides to listen to the media regarding cervical manipulation and the reported …. but unsubstantiated…claims of vertebrobasilar episodes I feel responsible to respond to their questions and concerns. If as stated above “we will play another game-a non-therapeutic one.” Should I be responding? I know I can’t prove anything and we must shut up or practice by different rules.
But here’s my question: What is the OSC stance on this issue of cervical manipulation and stroke?
What is an philosophically congruent response to a pm who voices this concern?
.
The diffference is how the manipulation is different from the adjustment. The studies show that there is a 1:10,000,000 chance of evoking the condition.
As an Objective Straight D.C. if you utilize upper cervical techniques as HIO, Togglee Recoil, NUCCA, or even low force methods as DNFT, the incidence is even a lower amount as no rotational component.
The specificity of only moving C-1 vs a rotatory HVLA thrust with torque, the latter has the highest propencity of evoking the stroke. It is clearly manipulation as ususally it involves multiples segments and cavitation is expected to make one think adjustment was successful.
Remember The audible is no indication adjustment to clear nerve interference was performed nor successful.
Manipulation is for mobility, not for improving nervous system function and reconnecting with Innate
Not even manipulations cause strokes. Watch Pacquiao manipulate Bradley’s neck this weekend in the ring. If twisting the neck caused strokes every pro boxer would be dead. There’s no way an adjustment could do that.
I find Dr. Brettmann’s reply very disturbing.
Eric,
WHY is Dr. Brettmann’s reply very disturbing to YOU?
Claude,
As a profession we need to get away from throwing our brothers to the dogs if they don’t practice the same way we do. It is pointless to try and suggest that one technique is safer than another with regard to CVA , first – because it is nonsense to make such a suggestion, and second – because the public does not give a rat’s knacker about technique. They are being potty-trained to associate stroke with chiropractors who work on the neck – period. I just read yesterday of a suit brought against a doctor who used an activator.
Claiming you use low force obviously will not insulate you in this situation if someone happens to have a CVA on the same day they came to your office. We must all work together to dispel this myth – not point fingers.
Also, since it came up later in this thread – properly applied “high velocity” rotational adjustment(s) can be just as specific as any other technique when it comes to LACVS. What on earth is the matter with “religious” technique worshipers!
Eric,
Thank you!
Dr. Seiler.
How do you suggest we dispel this myth?
And could you give me your perspective on the questions I posed to Dr. Lessard posted below (dated Don 06/13/2012, 12:06 am)?
I would really like to hear your opinion.
Thanks,
Don,
Sorry it took so long to rely.
I think there is enough research available to demonstrate the very low, and fully acceptable risk of CVA in association which chiropractic. I have even seen one study that shows the incidence of CVA being lower among chiropractic patient populations than the spontaneous occurrence of CVA within the general population. We need to have this kind of data handy when the concern is brought up by patients, and we have to support our colleges and state and national associations when they must respond to the media in such matters. And certainly, we must NEVER suggest that CVAs only happen with certain chiropractic techniques.
As far as leaving it up to medicine to prove the safety and efficacy of chiropractic…that is just plane ridiculous – as ridiculous as it is to suggest that understanding the best methods for caring for the body in sickness and health is the role of medicine. Chiropractic can and must have input in such matters (within a chiropractic paradigm of course). The chiropractic way of thinking is part of humanity’s best hope in getting away from a medical model of disease treatment. Chiropractors can certainly limit there practice to LACVS as Dr. Strauss suggests…but this is purely preference. Chiropractors who choose to broaden there approach to health are not necessarily mixing, and are certainly capable of being just as adept at LACVS.
.
Dr. Seiler,
Thank you for your reply.
Even if you believe it did take long to respond, you seem to be kept very busy by members on this site and it is definitely excusable 😉
Take care.
Manipulations and adjustments do not share the same objective and are not the same thing. In my opinion research fails to distinguish the difference.
I don’t feel that the OSC can even comment on the veracity of the claim as this it the medical realm.
What is the TSC view? and does this leave the OSC defenseless?
I know philosophically we can but is congruent with our objective to say that adjustments do not cause strokes?
I find Dr. Brettmann’s response confusing. This part in particular “The specificity of only moving C-1 vs a rotatory HVLA thrust with torque, the latter has the highest propencity of evoking the stroke.”
Maybe he can elaborate?
From Dr. Lessard found in another post..
Claude 06/12/2012, 10:14 pm:
This comment is from quick draw and goes under: Question from a reader.
Don,
Non-Therapeutic-Objective Chiropractors do NOT perform cervical manipulations. The NTOS-Chiropractor locates the subluxated vertebra. Analyzes its juxtaposition with with the vertebra above, below or both to determine its accurate listing. Selects a chiropractic technique of choice. Introduces a SPECIFIC thrust into the SPECIFIC subluxated vertebra as gently as possible by hands or with a chiropractic instrument. The INTENT of the NTOS-Chiropractor is that the innate intelligence of the body will use that SPECIFIC thrust that was introduced and that the innate intelligence of the body will PERFORM the SPECIFIC adjustment of the VS. Period. –
The practice member should be made aware of that.
Dr. Lessard,
I agree Chiropractors do NOT perform manipulations. They perform adjustments. The problem is that I find far too many Chiropractors and the media use these terms interchangeably.
I also find the subject of contraindications to Chiropractic care difficult to talk about. It just doesn’t seem as clear cut as other areas of practice where there is clearly a distinction between medicine and chiropractic. On the one hand I understand that surgery, pharmaceuticals and disease is the practice of someone other than the OSC but when it comes to contraindications to care I am not so sure.
Would it be fair to say that the NTOSC objective and practice of NTOSC does not relate to anything medical and a suggestion that adjustments cause stroke is the realm of medicine? My first guess is yes. Do we leave it to medical researchers to determine the veracity of these claims? My first guess is no.
Dr. Strauss suggested the need for further research and I agree. I just don’t know how this can be done while staying true to the objective of NTOSC.
Don,
– Philosophically, Chiropractors do NOT perform adjustments. The innate intelligence of the body does and HOW it does it… we have NO idea whatsoever. It is beyond the thinking mind (educated) and into the realm of the unknowable metaphysical aspect of chiropractic and of life.-
– WHO it is that I choose to BE, is understanding (standing-under) the awesome LAW OF LIFE as BJ called it in developing the philosophy and constantly observing its veracity. I choose to BE willing to have a beginner’s mind ready to UNLEARN the past and accept the NEW as it unfolds in the present. –
– Choosing to BE under the LAW OF LIFE gives me an ADIO perspective to discern WHAT to say to people. I never worry about having the “right” words or phrases or scripts. I know WHAT I say flows from WHO I choose to BE. That is WHY I insist in pointing out that it is ALWAYS about the WHO you choose to BE and NOT about the WHAT you say. Be WHO you choose to BE and your words will follow your BEING. It reminds me of the famous quote: “We never know how far reaching some thing we may THINK, SAY or DO today will affect the lives of millions tomorrow.” It is ALWAYS in that order: THINKER, THOUGHTS, THINGS! –
– With regards to contra-indications, in my opinion, there’s ONLY one: DEATH. A corpse does NOT have “flow” of mental impulses. If you find another one, I would like to know. –
– Regarding research… The NEW science like quantum physics seemed to be much more comfortable with the LAW OF LIFE than the majority of chiropractors. Physicists and cosmologists are fine with NOT knowing the nature of black holes, dark matter and non-matter, unified field, eternity (outside of space and time) and the fact that the visible world as we perceive it is 99.999% empty space made up of electrons and neutrons. Chiropractic philosophy has been embracing the NOT knowing of the metaphysical aspect of life for years now and continues to do so. Chiropractic has 33 rock-solid principles to stand-under with confidence. –
– I agree with Joseph that more research is needed and it will NEVER interfere with the objective of chiropractic. If it is TRUE science it will ALWAYS point to ADIO. – 😉
In the first visits you MUST address the difference between an adjustment and a manipulation.
You could say on 1st adjustment day “Mrs Jones, let me explain to you what we do and do not do to align the spinal bones.” Explain difference. “Mrs Jones, once the vertebra is in its correct alignment do you need an adjustment? (response should be NO). And Mrs Jones, if the spinal bones are in correct alignment could we manipulate them? (response should be YES).”
“Now Mrs Jones, I am telling you this so when you are asked what the chiropractor does you can tell them that we gently align the spinal bones to remove interference in the nerve system.”
When they come to you with this info about manipulation causing stroke, you are prepared – used the same speech – “Mrs Jones, this could be the case, however it is not relevant in our office, Remember that first adjustment we gave you and I explained what we do? And that we do NOT manipulate? (nodding head)” End of conversation.
You attitude toward this is crucial.
I used to be defensive and say “well you have a higher chance of getting a stroke getting you hair washed at the hairdresser.” but then you are still talking on a fear based level.
Dr. Tinker,
Thank you for your perspective. I agree approaching the situation with a proper attitude and explaining things in advance are necessary to avoid any potential conflict.