|The treatment involves locating,
diagnosing and correcting.
Spinal Adjustments and Naturopathy
Naturopathic Physicians as well as chiropractors, are licensed in British Columbia to use spinal manipulations (adjustments) within their scope of practice. This treatment involves locating, diagnosing and correcting joint and associated muscular dysfunction. These joint disturbances are called subluxations or fixations, which indicates locking, or misalignment of spinal or extremity joints. Subluxations can result in abnormal joint movement and be a cause of pain. The treatment involves the gentle re-setting of the joint restriction by adjustment. The adjustment may cause a clicking sound, or may be a gentle low force maneuver, which is barely felt. There are a great variety of techniques available to best address your needs.
The effect of the adjustment is to improve mobility and nerve function throughout the entire body. Consequently, you not only feel better, but also the improved autonomic nervous system effect will regulate circulation to all muscles and tissues as well as directly improve organ function, resulting in an overall health benefit.
The benefits of cervical spinal adjustments upon neck pain, whiplash, and headache have been extensively outlined in the Annals of Internal Medicine . A systematic review of 20 randomized clinical trials has addressed this issue, with the majority indicating positive, and the remainder yielding equivocal results. Neither negative results, nor significant adverse events to these cervical manipulations were shown [2,3].
Forty-three randomized trials of spinal manipulation for treatment of acute, subacute, and chronic low-back pain have been published. Thirty favored manipulation over the comparison treatments in at least a subgroup of patients, and the other 13 found no significant differences .
This study concluded that Naturopathic treatment was shown to have significant (95% CI) benefit in decreasing disability and pain due to chronic low back pain. Pain medication use was significantly reduced, and quality of life measures dramatically improved. The most significant changes occur within the first 4 weeks of Naturopathic treatment. In this industrialized setting, it appears that not only were Naturopathic treatments effective, but an individualized approach to back pain resulted in greater benefits compared with a physiotherapy equivalent previously shown to be effective.
- Local discomfort (53%)
- Headache (12%)
- Tiredness (11%)
- Radiating discomfort (10%).
- Reactions were mild or moderate in 85% of patients.
- Sixty-four percent of reactions appeared within 4 hours of treatment
- 74% had disappeared within 24 hours.
- There were no reports of serious complications in this study.
The research is not clear as to whether neck manipulations may be a cause of stroke or a triggering factor in already vulnerable arteries.
Recent biomechanical research has studied the strain, if any, that cervical adjustment may place on the vertebral arteries. The preliminary findings indicate that the movement of joints during cervical adjustment is done well within the normal range of motion and that cervical adjustment is " very unlikely to mechanically disrupt the vertebral artery" .
It is not possible to predict who specifically would be at risk for a stroke from cervical manipulation, but it is possible to recognize possible risk factors in your case history and examination and advise you appropriately. These may include a history of stroke, transient ischemic attacks (TIA), severe hypertension, and vascular disease.
Although spinal manipulation is associated with a very small but serious risk of complication, some patients occasionally choose to forgo high velocity low amplitude manipulation even with the precautions described in the side bar. In these cases, there are many other options for correcting spinal fixations/subluxations and relieving pain and discomfort without the use of conventional manipulation techniques, Often utilizing what are referred to as "low force techniques". These might include using Muscle release techniques, Activator Methods, Toggle adjustments, or other methods.
Other therapies that would be alternative methods of spinal correction or complement the effectiveness of manipulation therapy include:
Activator adjustment, toggle adjustment, acupuncture, Muscle Release Techniquesart, applied kinesiology, life style counselling, therapeutic exercises, prolotherapy. trigger point injection, neural therapy, scar therapy, hyaluronic acid injection, NET.
As explained earlier the risk of stroke from vertebral artery dissection following cervical manipulation is similar to the risk of spontaneous dissection. An editorial in the Canadian Journal of Neurological Science indicates that no clear cause and effect relationship has been established . Clearly more study is required to determine whether there is a risk relationship between cervical manipulation and stroke, what that risk might be and what screening methods are most reliable.
Many people with untreated neck pain and headaches take NSAIDS (non-steroid anti-inflammatory drugs). These include Aspirin, Ibutrophen, and Advil etc. The New England Journal of Medicine claims that in the U.S. 16,500 people die each year from the use of these medications . That is about 1 death for every 20,000 Americans per year (not all Americans are using NSAIDS). Recently the New York Times  reported that the FDA announced that 450 Americans die each year from the use of acetaminophen (Tylenol). There are 1 billion pills sold annually, calculations show us that there is one death per 2.22 million acetaminophen pills sold. Note that these statistics question the safety of using medication as opposed to cervical manipulation. In fact there is a greater risk of death from power boating, pregnancy, taking birth control pills, driving a car and other normal activities than from receiving a neck adjustment . Less conservative treatments such as neck surgery are also used for conditions very similar to the conditions treated with spinal manipulation. There is a 3-4% rate of complication for cervical spine surgery, and 4,000-10,000 deaths per million neck surgeries .
If you are considering lumbar spinal surgery, realize that there is a risk of death of 7 persons per 10,000 surgeries .
In risk management practices, 1 per million risks are considered acceptable, where as 1 per 100,000 risks are generally considered unacceptably high .
Let's put the concept of risk into perspective. This 2007 article in the Vancouver Sun looks at many risks that we are prone to on a daily basis without serious consideration. For example, a Canadian has a one in 226,165 chance of dying in a lawnmower accident, or a 1 in 255 chance of dying from poisoning. Consider that you are 65 times more likely to be killed in an automobile crash than an airplane crash.
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 Meeker WC, Mootz RO, Haldeman S. Back To Basics... The State of Chiropractic Research
Topics in Clinical Chiropractic 2002; 9 (1): 1-13
 Haynes MJ, Lesley AC, Melsom A, Mastaglia FL, Minle N, McGeachies JK. Vertebral Arteries and Cervical Rotation: Modeling and Magnetic Resonance Angiography Studies; J Manipulative Physiol Ther 2002; 25 (6): 370-383
 Meeker WC, Haldeman S. Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine; Annals of Internal Medicine 2002; 136: 216-227
 Haldeman et al; Arterial dissections following cervical manipulation: the chiropractic experience; CMAJ; Oct. 2, 2001; 165 (7)
 Rothwell et al; Chiropractic Manipulation and Stroke; Stroke. 2001;32:1054
 Shievink WT, Mokri B, Whisnant JP. Internal Carotid Artery Dissection in a Community: Rochester, Minnesota, 1987-1992; Stroke 1993; 24 (11): 1678-1680
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 Eric L. Hurwitz, DC, PhD; Peter D. Aker, DC; Alan H. Adams, DC; William C. Meeker, DC, MPH; Paul G. Shekelle, MD, PhD, Manipulation and Mobilization of the Cervical Spine. A Systematic Review of the Literature; Spine 1996 (Aug 1); 21 (15): 1746-1760
 Carey PF. A Report on the Occurrence of Cerebral Vascular Accidents in Chiropractic Practice; Journal of the Canadian Chiropractic Association 1993; 57 (2): 104-106
 Jaskoviak PA. Complications Arising from Manipulation of the Cervical Spine; J Manipulative Physiol Ther 1980; 3: 213-219
 Henderson OJ, Cassidy JO. Vertebral artery syndrome : In: Vernon H, ed. Upper Cervical Syndrome: Chiropractic Diagnosis and Treatment. Baltimore: Williams & Wilkins, 1988. 195-222
 Herzog, Symons, Leonard; Internal forces sustained by the vertebral artery during spinal manipulative therapy. Journal of Manipulative Physiologics and Therapeutics; October 25, 2002 (8); 504-10
 Lang, Eddy; Dissection, Vertebral Artery ; e-medicine website; February 12, 2004; http://www.emedicine.com/emerg/topic832.htm
 Guillon B, Levy C, Bousser MG; Internal carotid artery dissection: an update; J Neurol Sci. 1998 Jan 8;153(2):146-58.
 Hill, Michael; Cervical Artery Dissection,imaging,Ttrauma and Causal Inference; Can. J. Neurol. Sci 2003; 30: 302-303
 Wolfe M. M., Lichtenstein D. R., Singh G; Medical Progress: Gastrointestinal Toxicity of Nonsteroidal Antiinflammatory Drugs; N Engl J Med 1999; 340:1888-1899, Jun 17, 1999. Review Articles ; related article
 New York Times; Here's Something for That Headache; William Lee; March 17, 2004
 Dinman, B.D.; The Reality and Acceptance of Risk; Journal of the American Medical Association , Vol. 244 (11): 1126-1128, 1980
 The cervical spine research society editorial committee. The Cervical Spine, Second edition. Philadelphia: J.B. Lippincott Company 1990: 834 .
 RA Deyo, DC Cherkin, JD Loeser, SJ Bigos and MA Ciol Morbidity and Mortality in Association with Operations on the Lumbar Spine. The Influence of Age, Diagnosis, and Procedure
Journal of Bone and Joint Surgery 1992 (Apr 1); 74 (4): 536-543
 e-mail communication with Kenneth Green, risk advisor for the Fraser Institute, Vancouver, BC.
 Senstad O., Leboeuf-Yde, C., Borchgrevink, C., 1997, Feb 15, Frequency and Characteristics of Side Effects of Spinal Manipulative Therapy. Spine 22(4):435-440
 Ernst, E., March 2001, Prospective Investigations into the Safety of Spinal Manipulation Journal of Pain and Symptom Management, Volume 21, Issue 3 Pages 238-242
 Cooley PK, Szczurko O, Bernhardt B, Busse J, Seely D, Mills E; Low Back Pain: A Randomized Controlled Blinded Parallel-group Study; The Effects of Naturopathic Medicine on Health Outcomes in Low Back Pain: A Randomized Controlled Blinded Parallel-group Study, Canadian College of Naturopathic Medicine Trial