Stroke Patient Improves Under Chiropractic: A Case Study

In the April 17, 2017, issue of the Annals of Vertebral Subluxation Research is a published study documenting the case of a man who had suffered a stroke 18 years earlier being helped by chiropractic.

Stroke Patient Improves Under Chiropractic - Chiropractor Austin TX for Health Wellness Care Post StrokeAccording to the study authors, “Stroke is the leading cause of disability, third leading cause of mortality, and fifth leading cause of death in the United States.” They continue, “The Centers for Disease Control and Prevention defines stroke as something that occurs to interrupt blood flow causing brain cells to die within minutes due to the lack of available oxygen.” It is estimated that approximately 800,000 people suffer a stroke in the United States each year.

There are three types of stroke: ischemic, hemorrhagic and transient ischemic attack (TIA). Ischemic strokes, either transient or permanent, occur when there is some sort of blockage of an artery that brings oxygenated blood to the brain. These types of strokes account for 80% of the cases. The remaining 20% of strokes are hemorrhagic strokes, which is when an artery in the brain ruptures and leaks blood.

Statistics show that 40% of stroke survivors will experience moderate to severe impairments that require some form of specialized care. Of those, 25% will have minor impairments, and only 10% of those that have a stroke will recover almost completely. The statistics show that 14% of those who suffer one stroke will have another one. The mortality rate of those that suffer a stroke is not encouraging. Within 10 years of suffering a stroke, 32% of stroke victims die.

In this case, a 58-year-old man went to the chiropractor seeking relief from left hip pain that he rated as 8 out of 10 in severity. The man had tried therapy and cortisone shots which gave little relief. In his history, he noted that he had suffered a stroke 18 years earlier which left him with some residual paralysis bilaterally with little to no control over his fine motor skills and widespread muscle spasticity. His right hand was contracted in a complete fist which left it unusable. His motor skills were also impaired such that he had trouble putting on his jacket, buttoning it, or zipping it up. The man’s medical doctor told him that these effects were permanent.

A chiropractic examination was performed which included a postural evaluation, range of motion, palpation and spinal x-rays. Based on the finding of the presence of subluxations, chiropractic adjustments were started on a regular basis.

After a short period of time, the patient reported that his back pain had eased considerably. However, in addition to his back pain being helped, it was also noted that after two months of chiropractic, the man was able to turn the pages of a book with his right hand, something he had not been able to do since his stroke. Additionally, after eight months, he reported improvement in his fine motor skills, reduction of muscle spasticity, and overall easier movement. Over time, he was able to take his right hand, which had been locked in a fist, and flatten it out on a table. He also reported that he was able to move well enough to put on his own jacket, snap the buttons, and zip it without help. He also noted that he was able to workout on his home workout equipment, which was something he was unable to do since his stroke.

The man also noted one other interesting effect that he attributed to his chiropractic care. After chiropractic, the man visited his optometrist and was told that for the first time since his stroke, his eyewear prescription did not change. The man found this strange because at each optometrist evaluation visit since his stroke, his eyes had gotten worse.

In the conclusion of this study, the authors wrote, “The clinical progress documented in this case suggests that chiropractic care addressing the vertebral subluxation.”

If you or anyone you know could benefit from a better functioning nervous system, please call us at 512-452-2525 to schedule a consultation with Dr. Swanson. Austin chiropractor located in north central Austin, TX.


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Patient with Neck Pain and History of Neck Surgery Helped with Chiropractic

What is a Carotid Endarterectomy? Can Chiropractic Care Help Stroke Surgeries?

A case study published in the September 2016 issue of the Journal of the Academy of Chiropractic Orthopedists reported on a case of an elderly man with neck pain and a history of carotid artery surgery being helped by chiropractic.

patient-with-neck-pain-and-history-of-neck-surgery-helped-with-chiropractic-austin-tx-chiropractor-help-near-me-best-reviewsThe article begins by noting that nearly 140,000 people die each year in the U.S. from stroke. Stroke is the third leading cause of death behind heart attack and cancer. One of the leading causes of stroke is carotid artery disease. This is when plaque builds up in the carotid arteries and can prevent blood flow to the head. One medical procedure that looks to address this issue is called carotid endarterectomy (CEA).

On the Society for Vascular Surgery‘s website, Dr. Lori C. Pounds describes the procedure by saying, “A carotid endarterectomy is a surgical procedure to open or clean the carotid artery with the goal of stroke prevention.” It is estimated that 100,000 of these CEA procedures were performed in 2010.

In this case, an 83-year-old man sought care from a chiropractor. The man was suffering from right neck pain and an associated soft tender mass in the area. The pain began about a year and a half before he went to the chiropractor. There was no history of trauma or an accident as the trigger to his pain. His history revealed that he had undergone CEA surgery just less that three years earlier.

The man described his neck pain as a soreness which he rated as a 2 to 3 out of 10 in intensity, with 10 being the worst. He was taking prescription acetaminophen every 6 hours as needed for his pain. Two months before visiting the chiropractor, a computed tomography study showed cervical degeneration of his spine.

After a thorough examination, chiropractic care was started which included specific adjustments. The study reports that by the third visit, the man reported his pain to have reduced to a rate of 1 to 2 out of 10. By the following visit, he reported that he was pain free. At one point after that, the man did report a small re-occurrence of his pain which was quickly eliminated. Since that point, he has not had any neck pain.

In the study’s discussion, the authors note that, “Post-surgical pain is a common problem with a high degree of morbidity and a high overall cost effect.” They noted that this case demonstrated an effective approach to care for this case of an elderly man with pain who has had CEA surgery.

If you or anyone you know could benefit from a better functioning nervous system, please call us at 512-452-2525 to schedule a consultation with Dr. Swanson. We are located in north central Austin, TX.


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Stroke Risks While Under Chiropractic Care; No Evidence For Causation

With the recent headlines of chiropractic manipulation allegedly causing stroke we have listed some recent and relevant meta-analysis studies that have been done on this topic.  Below is a summary of the conclusions of some recent studies as well as a more in depth overview of the topic.

  • We found no significant association between exposure to chiropractic care and the risk of VBA stroke. We conclude that manipulation is an unlikely cause of VBA stroke. The positive association between PCP visits and VBA stroke is most likely due to patient decisions to seek care for the symptoms (headache and neck pain) of arterial dissection. We further conclude that using chiropractic visits as a measure of exposure to manipulation may result in unreliable estimates of the strength of association with the occurrence of VBA stroke. http://chiromt.biomedcentral.com/articles/10.1186/s12998-015-0063-x

stroke-risks-while-under-chiropractic-care-no-evidence-for-causation-austin-tx-chiropractor

According to the American Heart Association (2010), a stroke “…is a disease that affects the arteries leading to and within the brain. It is the No. 3 cause of death in the United States, behind diseases of the heart and cancer. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it starts to die…Stroke can be caused either by a clot obstructing the flow of blood to the brain (called an ischemic stroke) or by a blood vessel rupturing and preventing blood flow to the brain (called a hemorrhagic stroke)…The brain is an extremely complex organ that controls various body functions. If a stroke occurs and blood flow can’t reach the region that controls a particular body function, a stroke will ensue, then that part of the body won’t work as it should” (http://www.strokeassociation.org/STROKEORG/AboutStroke/About-stroke_UCM_308529_SubHomePage.jsp).

The AHA (2010) also posts signs and symptoms of an impending stroke. These include numbness or weakness of one side of the face, sudden confusion, difficulty speaking or understanding, problems seeing out of one or both eyes, sudden trouble walking, dizziness, loss of balance or coordination, and severe and sudden headaches with no known cause.

The blood supply to the brain is provided through the vertebral arteries and the carotid arteries. Problems in any of these arteries can result in the development of a thrombus (clot) or an embolism. If the thrombus is large enough it can occlude the normal blood flow. If an embolism occurs, it can move through the circulation into the brain and occlude blood flow. Either way, a stroke can be the result of these situations. One of the unique characteristics of strokes of this nature is that they can involve neck pain and headache.

Many patients will seek chiropractor care for neck pain and headaches. In the great majority of cases, the pain involved is not related to a stroke. However, on occasion, it may be. When the pain is related to a stroke, some of these patients developed a full range of stroke symptoms. Over the years, reports in the popular press and the scientific literature have suggested or stated outright that in patients who experience a stroke following chiropractic care, the stroke was caused by the chiropractor! We now know that this is very unlikely to be the case. What is far more likely is that the patient developed a thrombus or embolism in their vertebral arteries, producing neck pain and headache. This person sought health care for the pain. Whether they saw a chiropractor or their medical provider, they would progress on to a stroke at virtually the same rate. While the argument that the chiropractor caused the problem is convenient, the science indicates that it is in all likelihood a mistake to draw such a conclusion.

In 2008, Cassidy, Boyle, Côté, He, Hogg-Johnson, Silver, and Bondy  studied the occurrence of this problem in the province of Ontario over a nine year period with a database representing almost 110 million person-years (12.2 million people, studied over 9 years equals 110 million person-years). The purpose of this study was to investigate if an association between chiropractic care and vertebral basilar artery stroke exceeded the association between medical primary care providers and vertebral basilar artery stroke. The premise was that if there was a greater association between chiropractic care and this stroke then one could logically say there was a cause and effect relationship between chiropractic care and this problem. There was no greater likelihood of a patient experiencing a stroke following a visit to his/her chiropractor than there was after a visit to his/her primary care physician. The results were conclusive; there was no greater association between manipulation (chiropractic adjustments) and ischemic stroke or TIA’s (transient ischemic attacks).

The research did conclude that overall, 4% of stroke victims had visited a chiropractor within 30 days of their strokes, while 53% of the stroke cases had visited their medical primary care providers within the same time frame. The authors offer the perspective that because neck pain is associated with some stroke, patients visit their doctors prior to the development of a full-blown stroke scenario. Cassidy et al. (2008) noted, “Because the association between chiropractic visits and [vertebral basilar artery] stroke is not greater than the association between PCP [medical primary care providers] visits and [vertebral basilar] stroke, there is no excess risk of [vertebral basilar] stroke from chiropractic care” (p. S180). In fact, the incident of chiropractic vs. medical care was substantially lower in certain situations based upon the data.

In 2010, Murphy considered the argument that a chiropractic manipulation could cause stroke and concluded, “…if this is a possibility, it would have to be considered so rare that a case-control and case crossover study covering over 109,000,000 person-years failed to detect it” (http://www.chiroandosteo.com/content/18/1/22). He also reports that “… in 20% of cases of [vertebral artery dissection and stroke] the individual does not have neck pain or headache and in a very small percentage of vertebral artery dissections can occur in a person who has no symptoms of any kind. Thus, in cases in which an asymptomatic individual experiences [vertebral artery dissection and stroke] after [chiropractic manipulation] it is not clear whether manipulation was a cause or contributing factor to the dissection or whether the patient had an asymptomatic arterial dissection prior to the chiropractic visit” (Murphy, 2010, http://www.chiroandosteo.com/content/18/1/22). He concluded his report with the following, “…current evidence indicates that [vertebral artery dissection and stroke] is not a ‘complication to [chiropractic manipulation]’ per se. That is, the weight of the evidence suggests that [chiropractic manipulation] is not a cause of [vertebral artery dissection and stroke]…” (Murphy, 2010, http://www.chiroandosteo.com/content/18/1/22).

The real issue is not whether chiropractic or medical primary care causes stroke, as the research conclusively refutes this, but rather it is an issue of public awareness and perception. The argument must shift to the real issue of protecting the public and making people aware of the importance of recognizing risk factors and of getting immediate care to avoid long term disability or death.

Murphy (2010) offers the following advice, “…engage in a public health campaign to educate the public about the warning signs and symptoms of this uncommon but potentially devastating disorder…public education materials regarding stroke in general are available from organizations such as the American Stroke Association

 

(http://www.strokeassociation.org/presenter.jhtml?identifier=3030387 accessed 1 April 2010) the National Stroke Association

(http://www.stroke.org/site/PageServer?pagename=HOME accessed 1 April 2010) the British Stroke Association

(http://www.stroke.org.uk/information/index.html accessed 22 May 2010), the Heart and Stroke Association of Canada

(http:/ / www.heartandstroke.com/ site/ c.ikIQLcMWJtE/ b.2796497/ k.BF8B/ Home.htm?src=home accessed 22 May 2010) and the National Stroke Foundation – Australia

(http://www.strokefoundation.com.au/ accessed 22 May 2010)…” (http://www.chiroandosteo.com/content/18/1/22).

References:
1. American Heart Association, Inc. (2010). About stroke. Retrieved from http://www.strokeassociation.org/STROKEORG/AboutStroke/About-stroke_UCM_308529_SubHomePage.jsp
2. American Heart Association, Inc. (2010). Warning signs. Retrieved from http://www.strokeassociation.org/STROKEORG/WarningSigns/Warning-Signs_UCM_308528_SubHomePage.jsp
3. American Heart Association, Inc. (2010). Ischemic (clots). Retrieved from http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/IschemicClots/Ischemic-Clots_UCM_310939_Article.jsp
4. Cassidy, J. D., Boyle, E., Côté, P., He, Y., Hogg-Johnson, S., Silver, F. L., & Bondy, S. J. (2008). Risk of vertebrobasilar stroke and chiropractic care: Results of a population-based case-control and case-crossover study. Spine, 33(45), S176-S183.
5. Murphy, D. R. (2010). Current understanding of the relationship between cervical manipulation and stroke: What does it mean for the chiropractic profession?Chiorpractic & Osteopathy, 18(22),
http://www.chiroandosteo.com/content/18/1/22

Written by Gerard Clum DC, Past President, Life Chiropractic College West & Mark Studin DC, FASBE (C), DAAPM, DAAMLP

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Chiropractic Safety Documented by Study

What is a Cervical Artery Dissection? Do Chiropractors Cause Strokes?

On May 30, 2016, the the Annals of Vertebral Subluxation Research published a study titled, “Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation.” The researchers evaluated the evidence related to chiropractic manipulation and the form of stroke known as CAD. They found no causation.

Chiropractic Safety Documented by Study - Austin ATX Car Accident Truck Injury for Neck Whiplash Back PainOn a number of occasions, chiropractors have claimed that a smear campaign was being waged on their profession by baseless claims that chiropractic could cause strokes. This study looked at the actual scientific evidence to see if there was a causal relationship shown anywhere in the scientific data.

The study points out that there have been a number of case studies of patients who had CAD strokes following a chiropractic adjustment. However, this alone does not mean that the CAD was a result of the adjustment. As an example, there were probably also a number of people who have had car accidents at some point after a chiropractic adjustment. This would not mean that the chiropractic care caused the auto accident.

The researchers looked at the raw data to see what real scientific evidence there was for the claims. As the researchers stated, “We sought to examine the strength of evidence related to this question by performing a systematic review, meta-analysis, and evaluation of the body of evidence as a whole.”

Researchers did extensive searches for any references to chiropractic care and stroke. In so doing, they found 253 articles on the subject. Of these 77 articles were non-relevant and excluded. The remaining studies were reviewed for the strength of the evidence and the methodology leading to the results. Some studies showed no relationship with chiropractic and stroke, while some studies suggested that the risk was due to the condition that the patient had prior to the chiropractic care. In these studies, the stroke risk was the same, regardless if the patient went to a chiropractor or a medical doctor.

After reviewing all available studies, the researchers concluded that there was no evidence to suggest that chiropractic caused stoke. “We found no evidence for a causal link between chiropractic care and CAD.” They further explained the impact of their findings by noting, “This is a significant finding because belief in a causal link is not uncommon, and such a belief may have significant adverse effects such as numerous episodes of litigation.”

If you or anyone you know could benefit from a better functioning nervous system, please call us at 512-452-2525 to schedule a consultation with Dr. Swanson. We are located in north central Austin, TX.


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