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Strokes Following a Chiropractic Manipulation

By John Macfarlane on June 28, 2016


The medical malpractice team with Younker Hyde Macfarlane have significant experience representing persons injured by a chiropractor.  Their investigation in chiropractic cases focuses on the amount of medical investigation or workup that is done prior to manipulations (also referred to as adjustments), the method and manner of manipulation, and recognizing symptoms of a stroke or other injury following a manipulation. 

Chiropractic care can be helpful when the right manipulation is performed under the appropriate circumstances.  However, improper workup or overly aggressive manipulation can lead to injury including a vertebral artery dissection and stroke. 

Types of Chiropractic Manipulation

Chiropractors should be trained and prepared to offer a wide variety of treatment depending on a patient’s presenting symptoms.  Treatments vary depending on the area of the body being treated, the nature of the symptoms, and the information obtained from imaging and other diagnostic techniques prior to manipulation.  They can include the use of instruments, electric stimulation, or other adjunctive therapy. 

  • Diversified Technique: The most commonly known and, widely used, manipulation is called a diversified technique or a high-velocity, low-amplitude thrust.   This technique involves bringing a joint to a point of natural resistance and applying a short thrust past the point of resistance.  This can result in an audible “pop” in the spine.
  • Gonstead Adjustment: The Gonstead adjustment is similar to the diversified technique, but differs in the evaluation of the problematic joint and specificity of the body positioning.  This adjustment may involve a specially designed table or chair in order to properly position the patient, such as a cervical chair or chest-knee table.
  • Thomson Terminal Point (or Drop): This technique utilizes specialized treatment tables that have sections that drop a short distance during the thrust of the manipulation.  The table drop is meant to facilitate movement of the affected joint.  This adjustment may not result in an audible popping sound because it is considered a more gentle adjustment or a form of mobilization.

Chiropractors can also perform spinal mobilization or low-force techniques.  This is a gentler approach and can be employed when a patient’s condition, pathology, size, comfort, or even preference call for it.  Some examples of mobilization include:

  • Activator Method: An activator is a spring-loaded, hand-held manual tool that has a low force impulse.  The patient is typically lying face down on the adjustment table during the manipulation.  The chiropractor typically will evaluate leg length, perform some muscle testing, and adjust the extremity joints or spine using the tool.  This is probably the most common type of gentle manipulation performed by chiropractors.
  • Cox Flexion-Distraction: This technique involves a gentle manual manipulation designed to adjust or manipulate the vertebrae by applying a gentle stretch over the lower spine.  This technique usually involves a series of slow and repetitive movements that can be described as a rocking motion.
  • Toggle Drop: During this manipulation the chiropractor uses crossed hands, one on top of the other, and presses down quickly and firmly on the affected area of the spine while a section of the drop table falls in order to facilitate the adjustment.

Chiropractic Manipulation and Stroke

Patients seeking chiropractic care for cervical spine pain or stiffness are often manipulated using the diversified technique.  As described above, this involves turning a patient’s head to the point of natural resistances and then performing a short thrust past the patient’s natural range of motion. The picture to the right shows the vascular anatomy in the area of the cervical spine and shows the vertebral artery passes through the area of the cervical spine.      

An aggressive manipulation can cause a vertebral artery dissection or expand a pre-existing dissection present at the time of manipulation.  In fact, medical physicians treating persons that present with a stroke secondary to a vertebral artery dissection often ask the patient if they have recently been seen by a chiropractor.  A vertebral artery dissection can lead to a stroke by disrupting the flow of blood to the point that the blood begins to coagulate and clot.  The clot can then travel to the brain and cause a stroke.   

Most Chiropractors are either not aware of the risk of vertebral artery dissection or believe that the risk is so low that the patient does not need to be warned of the risk prior to manipulation.  Additionally, it is important for chiropractors to be aware of the signs and symptoms of stroke and refer patients to the emergency room if they exhibit any signs of symptoms of a stroke, either before or after their manipulation. 

Signs and Symptoms of a Stroke:

A stroke can manifest in different ways, but any of the following signs or symptoms, particularly following a chiropractic manipulation, requires an immediate medical evaluation in the emergency room:

  • Face droop
  • One sided numbness or tingling
  • Arm weakness
  • Speech difficulty
  • Numbness or tingling in the extremities
  • Severe Headaches

Chiropractors should be aware of and inform patients of these signs and symptoms in the event they experience these symptoms following a manipulation.  Chiropractors should also be evaluating each patient through imaging and appropriate questions to determine whether manipulation is appropriate and safe.  In many cases, a patient may have a neurological impairment that cannot be remedied by manipulation.  In fact, a manipulation without proper work up can result in additional injury as a result of the manipulation. 

How an Attorney Can Help You

Given the complexity and severity of injuries caused by chiropractic manipulation or malpractice, it is important to contact an attorney quickly if you have been injured by a chiropractor.  The attorneys at Younker Hyde Macfarlane will assist you in evaluating and prosecuting all valid claims you may have.

Contact the Medical Malpractice Team at Younker Hyde Macfarlane

For more information about your legal options related to a chiropractic injury or stroke, please contact our team of medical malpractice attorneys today.  The legal team at Younker Hyde Macfarlane will fight diligently for you and your legal needs.   

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