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“I had no idea”

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

A tragic story from Alberta: ‘I had no idea’: Calgary mom says she had a stroke after a chiropractor visit.

What if she’d had an idea? If this patient had understood the high stakes risk and underwhelming benefits of neck adjustment — if someone had explained it to her — she would probably have walked away. Informed consent to the rescue.

Sure, risk your life on a mediocre-at-best neck pain treatment if you want.

But most people don’t want.

I use stories like this to remind my readers of the lousy ratio of risks to benefits of neck adjustment. The risk is remote, but the stakes are high: strong, sudden rotation of the neck (no matter how “expert”) can break your neck parts, usually an artery. You need those parts. They are important parts. Breaking them is bad. And it’s just not worth it for a treatment that has mediocre therapeutic value at best. The evidence of the efficacy of cervical adjustment is overwhelmingly underwhelming.

Some chiropractors exert themselves trying to defend their profession from the serious implications of these rare but awful events. In particular, they will point out that we don’t know if neck manipulation actually causes these disasters, or if it simply quickly finishes off people who were already breaking all by themselves. No one cares! It’s a terrible outcome either way! When you have a neck artery fraying like an old rope, going to a chiropractor might work out. She might spot the warning signs and refer you to the hospital. Or she might go ahead and adjust your neck and shred the artery. Is that preferable? For a treatment you didn’t need in the first place?

The fact that we don’t know which came first just punctuates that it could be either… and neck adjustment is still a terrible idea.

This is an exasperated “rant,” obviously. For calmer, more thorough, and referenced exploration of the topic, which I have been writing about for twenty years now, see: Does Spinal Manipulation Work? Spinal manipulation, adjustment, and popping of the spinal joints and the subluxation theory of disease, back pain and neck pain

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