| Abstract/Notes |
The relationship between cervical manipulative therapy (CMT) and vertebral artery dissection and stroke (VADS) has been a source of great controversy for many years. A great deal has been written about this topic, from emotionally charged commentaries to high quality science. The evolution of our knowledge about the relationship between CMT and VADS has evolved considerably, from a few case reports to surveys to biomechanical studies and, finally, to large case control studies. The purpose of this presentation is to follow the evolution of the literature regarding this relationship to where we are today and to help the practising chiropractor and policy makers understand the various issues related to CMT and VADS. In addition, to make recommendations as to what the responsibility is of the practising chiropractic with regard to CMT and VADS. The current understanding, based on the evidence to date, suggests that while there is a clear, though rare, temporal relationship between CMT and VADS, no plausible causal connection can be made. It appears that, as the most common initial symptom of vertebral artery dissection is neck pain and headache, there are instances in which a patient who has these symptoms, without obvious manifestation of stroke, consults a chiropractor for the neck pain and headache, and subsequent to this experiences a full stroke, independent of anything that the chiropractor does or does not do. This current understanding has changed the responsibility of the practitioner from one of “screening” to one of diagnosis and public health education. This abstract is reproduced with the permission of the publisher; full text by subscription.
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