Chiropractic and Stroke – And not what you may be thinking:
New evidence adds weight to previously published cases reporting the potential benefit of chiropractic care for stroke survivors
Globally, stroke is a leading cause of death and disability. The incidence is growing, and the millions of people that survive stroke suffer from long-lasting physical disabilities that greatly impact enjoyment and quality of life. Commonly occurring and long-lasting physical disabilities include impaired limb movement and function affecting the individual’s ability to stand, balance or walk, leading to further compromised independence.1
The chiropractic adjustment has at times attracted untoward media attention as a result of infrequent, isolated cases of stroke following “neck manipulation.”2,3 However, scientific evidence establishing a robust statistical correlation or a causal relationship between specific chiropractic care and stroke is lacking, and many of the few cases citing “chiropractic” as the cause of stroke have been grossly misrepresented.4-6
Improvements in Chiropractic patients presenting with a wide array of health concerns, from hypertension to multiple sclerosis to birth outcomes and more, have been reported in numerous peer-reviewed publications within and outside of the Chiropractic profession. The potential benefits of chiropractic care for stroke survivors in particular, however, is rarely reported in published form, though vast functional improvements may be seen regularly by chiropractors in the field. Only a handful of case reports have been published over recent years describing the improvements in physical function of stroke survivors that are receiving chiropractic care.7-9 Given the known effects of the chiropractic adjustment on brain function and therefore the potential dramatic improvements that may be realized in a stroke population, it’s not surprising that published research describing the benefits of chiropractic care has begun to accrue and attract attention.
In one such case, a 59-year-old male with an 18-month history of hemiparesis following a stroke subsequently received Diversified adjustments over 6-weeks and resulted in improvements in upper and lower limb motor function (tandem walk, heel/toe walk, modified Rhomberg’s position, grip strength and dexterity proprioception).7
In another case, a 31-year-old male received 32 weeks of manual chiropractic care 4 years after surviving a stroke and experienced improvement in non-assisted walking and global improvement in balance and movement patterns.8
In a third case a 58-year-old male received Thompson and Diversified adjustments over a 13-month period 18 years following a stroke, the results of care included improved fine motor function and reduced spasticity.9 These objective, quantifiable improvements in brain-based function in patients who would have otherwise been expected to experience no further clinical improvement highlight the potential power of Chiropractic care for this patient population.
One recent development supporting this exciting possibility is a newly published cross-over trial that strengthens and supports the findings from these and other previously reported cases.10 This new publication is published in Scientific Reports, a highly regarded peer-reviewed periodical published by Nature.
The study, undertaken by the team from the New Zealand Centre for Chiropractic Research and their collaborators, demonstrated that a single session of chiropractic care increased lower limb muscle strength and altered cortical drive (brain function) in stroke survivors. Twelve subjects were used in the study, and the chiropractic care provided in the study was specifically focused on the assessment and correction of vertebral subluxation. Chiropractic adjustments were either manual (high-velocity, low-amplitude) or instrument assisted as determined by the chiropractor.
The study subjects were measured for their muscle strength of plantar flexion before and after a single session of chiropractic care or a control intervention (sham adjustment). Electrical stimulations of the Tibial Nerve were used to elicit V waves, which can be used to show how well the brain can drive muscles, and to test the H reflex which demonstrates excitability within the spinal cord. The results of the study showed improvement in motor strength of close to 65%, and the V wave and H reflex analysis suggests the improved motor strength is due to changes in the way their brain communicates with the muscles. These findings suggest that chiropractic care focused on the correction of vertebral subluxation may significantly benefit brain injury patients by quantitatively improving brain function, and providing a reasonable neurophysiological explanation for the clinical improvements previously reported in stroke patients under chiropractic care.
The International Federation for Chiropractors and Organizations (IFCO) recognize that a vertebral subluxation is “an alteration of the intervertebral relationships of one or more articulations of the spinal column or the immediate weight bearing components of the axial skeleton; accompanied by a change in the morphology of the tissue occupying the neural canal and/or intervertebral foramina; as well as an alteration of neural function sufficient to interfere with the transmission of organizing information, considered to be homologous to the mental impulse.”
The IFCO promotes public access to regular chiropractic care for the assessment and correction of vertebral subluxation. As with all patient care, caution must be taken so that appropriate chiropractic care is given only after a thorough patient history and clinical examination has been performed. The thoroughness of the history and examination are to ensure the safety of and best results for the patient; to determine the levels and severity of vertebral subluxation; to determine which optimal specific adjustments are to be used; and to determine the course of care which is appropriate for a patient’s individual needs. Such examinations should be conducted only by Doctors of Chiropractic employing objective methods for location and correction of vertebral subluxations.
Further studies are necessary and underway already. The IFCO and its affiliates seek to support and expand the profession through scientific investigation into the ill effects of vertebral subluxation and the beneficial effects the chiropractic adjustment.
Article published in collaboration by the IFCO Science Committee, with primary writing and research contribution provided by David Russell, BSC (Psych), BSC (Chiro), CERT TT
- Krishnamurthi RV, Moran AE, Feigin VL, Barker-Collo S, Norrving B, et al. Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Adults Aged 20–64 Years in 1990–2013: Data from the Global Burden of Disease 2013 Study. Neuroepidemiology 2015;45:190–202
- Norris JW, Beletsky V, Nadareishvili ZG. Sudden neck movement and cervical artery dissection. The Canadian Stroke Consortium. CMAJ 2000;163:38–40
- Ernst E. Manipulation of the cervical spine: a systematic review of case reports of serious adverse events, 1995–2001. Med J Aust 2002;176:376–80
- Cassidy DJ, Boyle E, Côté P, He Y, Hogg-Johnson S, et al. Risk of Vertebrobasilar Stroke and Chiropractic Care Results of a Population-Based Case-Control and Case-Crossover Study. Spine 2008;33(45):s176-s183
- Church EW, Sieg EP, Zalatimo O, Hussain NS, Glantz M, et al. Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus 2016;8(2): e498
- Terrett AG. Misuse of the literature by medical authors in discussing spinal manipulative therapy injury. J Manipulative Physiol Ther 1995;18(4):203–10
- Marsillo R, Vitale A, Tarnoff E. Clinical assessment and rehabilitation of a stroke patient. ACC-RAC Platform and poster presentation abstracts. J Chiropr Educ 2006 Spring;20(1):35-36
- Oppelt M, Juehring D, Sorgenfrey G, Harvey PJ, Larkin-Their SM. A case study utilizing spinal manipulation and dynamic neuromuscular stabilization care to enhance function of a post cerebrovascular accident patient. J Bodyw Mov Ther 2014;18:17-22
- Dutton T, Pallis RJ. Improvement in major residual effects of stroke following chiropractic care to reduce vertebral subluxation. A Vertebral Subluxation Res. April 17, 2017:64-71
- Holt K, Niazi IK, Nedergaard RW, Duehr J, Amjad I, et al. The effects of a single session of chiropractic care on strength, cortical drive, and spinal excitability in stroke patients. Scientific Reports. 2019;9:2673