Reflection 1

Reflection 1
Cervical manipulation association with VAD/CAD.
My first experience with a cervical manipulation was during a session I had 12 months ago
from a chiropractor. As my practitioner focussed on cervical mobilisation, she explained
how she would make the muscle tension knots in my neck disappear. I always looked
forward to soft tissue therapy as it was pleasant and effective. From previous experience, I
felt more relaxed and less restricted when I rotated my neck from side to side. I was
definitely impressed but also had mixed emotions because I also felt anxious and worried.
My concerns were generated from hearing many frightening stories of how some people
experienced a stroke after having a neck adjustment.
I started to question whether I should consent to the soft tissue therapy or mobilisation
technique only and object to the full cervical manipulation.
It was a great opportunity to seek further advice and knowledge during my class session
when discussing Vertebral Artery Dissection(VAD) and Cerebral Artery Dissection (CAD). This
would enable me to understand the signs and symptoms and the risks involved.
During class, my peers and I had the opportunity to practice on a mannequin. This was
excellent because I had the chance to experiment with applying the technique without
having to worry about hurting anyone or worse, causing serious consequences.
Our first two main techniques included the lateral flexion restriction and lateral rotation
restriction. Our mock thrusts consisted of the pillar push and index rotation. I found this to
be quite exciting, as I felt like we were advancing into the main common areas of what
chiropractors face on a daily basis. Particularly, in this generation where texting syndrome is
a household issue, neck tension and forward head carriage are on the rise.
As we spent two hours learning and practising on the mannequin, it was time to apply these
techniques on our peers. We had to obtain clearance from the chiropractic clinic in order to
proceed.
I was nervous to perform these applications as I feared that I could potentially injure or hurt
my fellow partner. This hindered my ability to coordinate my primary and secondary
contacts as I was too consumed with my partner’s facial expression to observe whether I
was inflicting discomfort at any point.
After this class, I decided to research further in addition to our weekly lectures about the
risks of cervical dissections following a neck manipulation.
The research data was quite reassuring. The statistics stated by Haldeman et al, (2001)
expressed that less than 1 in 5.9. million, experienced an episode after being treated by a
chiropractor. On the other hand, the risk of spinal injury was 1,800 per million. This was
reassuring to know that as a future chiropractor the chances are extremely rare. Whereas
the statistics following spinal surgery are substantially higher. This is an indication of the
stigma attached to the chiropractic profession in comparison to surgeons.
Upon further discussion with our teacher and class peers, there was reassuring opinions and
stories exchanged from their own experience with their encounters with chiropractors. I
need to determine during a scenario with a patient of whether to adjust or not, and not be
afraid to adjust if the need arises.
I was pleased to learn that cervical adjustments benefit far outweigh the risks involved.
Also, CAD/VAD could be as a result of underlying or existing issues that can arise in multiple
scenarios, not merely triggered by a chiropractic session. This was reinforced by Lee et el
(1995), where they expressed the lack of significant methodological quality to establish
definitive causality. Moreover, there is no sufficient evidence to support cervical or
vertebral artery tests to identify patients with a higher risk than others. As a result, these
tests attain a low validity and a low reliability rate (Kerry et al, 2008).
The aforementioned research has strengthened my confidence and belief that positive
outcomes can be achieved with cervical adjustments and that the negative stories should
not deter me from optimising my competence when performing mock thrusts during class
or in the future as a practising chiropractor. Furthermore, a thorough physical examination
and history taking assessment regarding the time of onset of symptoms is of paramount
importance for detecting subtle symptoms and signs of CAD and VAD.
References
1. Haldeman, S., Carey, P., Townsend, M., et al. (2001). Arterial dissections following
cervical manipulation: the chiropractic experience. CMAJ. 165, 905-906.
2. Kerry, R., Taylor, A.J., Mitchell, J., et al (2008). Manual therapy and cervical arterial
dysfunction, directions for the future: a clinical perspective. J Man Manip Ther. 16,
39-48.
3. Lee, K.P., Cslini, W.G., McCormick, G.F, et al. (1995). Neurologic complications
following chiropractic manipulation: a survey of California neurologists. Neurology.
45, 1213-1215.

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Cervical manipulation association with VAD/CAD.

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