- Chiropractic Resource Organization.     Support Chiropractic Research!

Daily Archives: November 22, 2012

The Mechanics of Neck Manipulation With Special Consideration of the Vertebral Artery

By |November 22, 2012|Chiropractic Care, Stroke|

The Mechanics of Neck Manipulation With Special Consideration of the Vertebral Artery

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc. 2002 (Sep); 46 (3): 134–136

Dr. W Herzog, BSc, PhD and Dr. B Symons, DC

University of Calgary,
2500 University Drive N.W., Calgary,
Alberta, Canada T2N 1N4.

In recent weeks, we have learnt that chiropractors may have to carefully review the application of high-speed, low-amplitude spinal manipulative treatments to the neck. The concern is the possible risk associated with neck manipulation. Specifically, vertebral artery dissection, or ther mechanical injury, are an acknowledged, albeit a very low, risk.

The vast amount of research on vertebrobasilar injury in the past has been focused on blood flow through the vertebral artery during diagnostic, and before and after manipulative treatment. There was (is) concern that vertebral artery occlusion may occur during neck manipulation, and that a lack of blood supply to the brain may lead to a series of complications. This line of argument has always struck us as weak, because a high-speed, low-amplitude thrust to the cervical spine lasts typically less than 150 ms, and the brain has sufficient oxygen to survive such a small amount of (possible) loss of blood flow from one of its many supply arteries.

Another way of attempting to gain insight into the possible risk of neck manipulation and vertebrobasilar accidents is a statistical (epidemiological) approach. The basic question that people would like to answer is: are people who receive neck manipulative treatments at a greater risk of vertebrobasilar accidents than people who do not receive such treatments? On the surface, this approach seems feasible, and so it would be, if the occurrence of such accidents was high (let’s say one time in a hundred or a thousand). However, it appears that we deal with incidence rates (if there is an actual incidence) of one in several millions (i.e. very low). Therefore, any statistical pproach has a miniscule power, and a couple of “fluke accidents” (i.e., accidents that occur, let’s say in a chiropractic clinic, but in reality have nothing to do with the chiropractic treatment) may produce a “statistical error” that may persist for years in a community as small as Canada.   Also, using an epidemiological approach, the question of “cause and effect” cannot be resolved.

When starting to tackle the problem of the mechanics of neck manipulative treatments three years ago with my student B. Symons (DC), we were surprised that, to the best of our knowledge, there were no data on what actually happens mechanically to the vertebral artery during cervical spinal manipulation. I was further surprised, when asked to review a case on a vertebrobasilar accident, that one of the arguments went as follows: Pathology revealed no dissection of the vertebral artery, therefore, the vertebrobasilar accident cannot be associated with chiropractic treatment.

Discussing this particular statement within the chiropractic community, it became apparent that mechanical injury to the vertebral artery was an accepted, but very, very very rare occurrence; but nevertheless, accepted. And all this without a shred of scientific evidence about the mechanics of the vertebral artery during cervical manipulation.

So, when does the vertebral artery, or for that matter, any tissue, become injured?


Lives Lived – Ronald Gitelman, DC

By |November 22, 2012|News|

Source Globe and Mail

by Howard Vernon, DC

Chiropractor, husband, father, outdoorsman, craftsman. Born Jan. 26, 1937, in Trenton, Ont., died Oct. 7, 2012, in Toronto from pancreatic cancer, aged 75.

Whether it was seeing a patient, delivering a lecture, casting his handmade fly rod, carving a piece of wood into a beautiful bowl or walking with his beloved granddaughter, Jennie, nobody did it better than Ron.

He had a zest for life, a love of each day, a sense of humanity, a passion to experience things, and the most engaging smile.

Growing up in a small town close to countryside, Ron had an affinity to nature his whole life. He was happiest in the country, and sought it out all his life.

He was a natural athlete. While playing tennis as a teen, he developed a shoulder problem and an orthopedic specialist told him he needed an operation and that his tennis career was over.

Ron could not accept this, so he rode his bike up the mountain to the office of a man whom the kids used to call a quack who broke bones. Ron thought perhaps the man could help him.

The man was named Dr. Halett, and he was Trenton’s chiropractor. He examined the shoulder, and had Ron back on the courts, free of pain, in two weeks.

That encounter ignited the spark that led Ron to the Canadian Memorial Chiropractic College.

After graduation, he devoted 40 years to his patients, his educational institution and the profession at large.

From 1963 to 1978, he made several fundamental contributions to chiropractic science: He developed the first scientific database for chiropractors; delivered a lecture at the 1975 National Institutes of Health conference on spinal manipulation, one of the few chiropractors to speak there; and was instrumental in developing chiropractic research.

Ron continued to practise until 2007, when he retired to his cherished chalet in the Beaver Valley near Georgian Bay, where he could devote all his time to his family, his many pastimes and his love of nature. He contributed greatly to the maintenance of the Beaver River.

Ron revelled in the successes of his children, who grew up to be a world-renowned bridge player, a nature conservationist and a teacher. He loved nothing more than to have his close and extended family enjoy the chalet and all the outdoor experiences it provided.

As Ron’s final illness emerged, he said he’d had a great go at life and his bucket was empty, though he thought there might be one last “permit” still in the bucket (still hoping to catch the big one!).

He challenged his illness like he did every other problem in life – head-on and with a sense of determination.

We know that Ron would want us to catch and release, stop and smell the forest, laugh at a good joke and celebrate life the way he did.

We lost a great friend, healer and teacher.

Howard Vernon is Ron’s friend.