Manipulation for back and neck pain 'carries stroke risk'

People who seek treatment for neck or back pain from a chiropractor, osteopath or physiotherapist offering spinal manipulation may be putting themselves at risk of a stroke or other serious injury.

People who seek treatment for neck or back pain from a chiropractor, osteopath or physiotherapist offering spinal manipulation may be putting themselves at risk of a stroke or other serious injury.

Although the risk is small, the consequences can be devastating, leading to stroke, nerve damage, partial paralysis and lasting disability, a new study suggests.

The popularity of spinal manipulation has soared in the past decade and tens of thousands of people now consult therapists every year. But no systematic study of the risks of the treatment they provide has been done in Britain.

A pilot survey of 239 consultant neurologists found 24 who recalled at least one case of a serious neurological complication after manipulation of the cervical spine (the neck) occurring in the 12 months from August 1998 to July 1999. The commonest injury was a stroke caused by damage to the arteries in the neck or the blood vessels in the brain.

One woman admitted to hospital four hours after having her neck manipulated was found with damage to her vertebral artery, which was blocked by a blood clot. Next morning she was barely conscious and had to have surgery to reduce the swelling in her brain. She was left with problems walking.

All the cases were within 24 hours of manipulation. The researchers, from the department of complementary medicine at Exeter University headed by Professor Edzard Ernst, are now planning a long-term study to establish the true scale of the danger from spinal manipulation.

Clare Stevinson, who led the pilot study, published in the Journal of the Royal Society of Medicine, said it was only manipulation of the neck that carried the risk, and it seemed to be higher when the head was rotated sharply. "Trying to avoid practitioners who use the rotational technique might be one way of reducing the risk," she said.

The British Association of Chiropractors said the study did not examine the profession or qualifications of those doing the manipulations, nor why they were done, and did not check the medical histories of the patients affected. Sue Wakefield, the director, said: "Chiropractic is safe in skilled hands. In other studies around the world, the risk has been shown to be between one and three per million manipulations. People twisting their neck to reverse a car can suffer the same effect.

"The association would welcome robust and thorough research into this subject."