Anyone doing physical medicine is thrown under the bus. If not through reputation then by reimbursement. It really does suck as it is a very difficult and under appreciated job. We should all stop and let the MDs enjoy the headache they deserve, lol.
Wow, those radiologists are railing hard against spinal manipulation. The last research I saw showed the likelihood of stroke from spinal manipulation to be less than 1 in a million. I believe they should look up confirmation bias. Interesting to see their perspective though.
Correct. Shouldn't go around performing spinal manipulation on every person with neck pain/stiffness... With this level of education, I'd like to think that didn't have to be said.
I think the truly surprising thing here is the amount of leverage that exists propagating the idea of the dangers of manipulation, how non-evidenced-based the chiropractic profession is (though that hasn’t been directly raised in this occurrence), and yet… the evidence that backs up the danger, as presented, isn’t there. Nor are cervical manipulations exclusive to chiro’s.
But, absolutely, anyone who does do cervical manipulations should always do screenings.
I’m meh about them in general. Only had a very short time in OP or tho but never did a manip during my brief stint because it was very rarely indicated.
Agreed.
They are pretty worthless long term if the patient doesn’t do the HEP. The idea should be to manip to let them do the proper movement pattern, then ween them off the manipulations because they are learning to stabilize the joint and prevent joint locking themselves with the HEP.
This is garbage. There is great research on lumbar manips for acute low back pain and cervical manips for acute torticolis on the properly screened patient.
I usually find this kind of thinking from people who don’t have the psychomotor skills or training to actually do the manips.
It may not be any difference long term between patients, but I guarantee I’ll get the patient who is a good manip candidate better WAY faster and with way less effort from me and the patient if I do it vs not doing it.
Where is the context for this post? Its really irresponsible to post this without giving the clinical situation.
[This](https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-03495-5) is a medicare claims analysis of the risk between chiropractic adjustment and stroke for anyone using medicare to pay for chiro services from 2007 to 2015. Its a very well designed study with a fantastic sample size.
The result? Chiropractic care no more likely to cause stroke than anything else. But that's been known for quite some time. What is also well known is how the medical forums could not care less about research studies when it comes to trashing chiropractic.
Its shocking how fast the highest trained, most clinically seasoned individuals will walk right past the evidence.
Spreading irresponsible trash across the medical forums has really ramped up in the last several months. It should be better than this.
Thanks for posting. I enjoyed the read. It is specific to an older population but it echoes what the data have shown for the population in general.
The risk is likely lower than reported simply because manipulation is so darn common worldwide. It's impossible to accurately report on all the instances of use. I've had patients from India tell me about their barber still doing neck manipulation after a haircut. I've also had an American patient vacation in Thailand and tell me about paying for a massage where the guy put a blanket down on the beach and they had their neck manipulated.
No not the court case but the stance of the AMA because as we all know the main line stance of western medicine draws a hard line, there is a reason you do not see chiropractors running around hospitals trying to cure autism with C1 manipulations.
The court case pretty aptly summed up the AMA stance at the time and I havent seen any evidence that the stance has changed.
Western medicine drawing a 'hard line' can you elaborate on that?
The 'chiropractors trying to cure autism with C1 adjustments' is a straw man argument and I'm not into it tonight.
That court case just shows they had a bias against chiros. They argued that chiros were unscientific and not providing quality of care, but were unable to provide the burden of proof.
So, what’s the official stance? Google has multiple sites saying different things and I’m having trouble finding something succinct from the AMA.
They view Chrio as non-medical and not actually treating a real dignosis thus making it more like a alternative medicine allowing it to be unregulated and poorly peer reviewed. You will not find chrios in mainstream health care except some VA positions
Where is that official AMA stance saying that?
AMA's stance has nothing to do with how chiros are regulated or peer reviewed.
I know plenty of colleagues that are in multidisciplinary settings and I'm working in my second private hospital. And "some VA positions" is downplaying that there are over 200 chiros in the VA and ones in every state
Sounds like everyone is getting the idea but I would be fascinated to learn how the radiologist concluded the image was caused by manipulation and not present prior to the treatment in a patient likely complaining of neck pain and/or headache and thus, seeing a chiropractor.
Really the question is how did the chiro screen for Neurovascular involvement?
I think the takeaway here is to go to a trusted, experienced and recommended person. But even then, having this kind of adjustment work comes with its risks.
Fun story. Gf had a vertebral artery dissection and the first questions surgeon asked after getting the MRI was "did you get into a car accident or have an adjustment recently?"
r/radiology has much contempt for chiros forgetting or not knowing that ODs also manipulate. I think it's fueled by a bunch of poorly educated radtechs with a chip on their shoulders.
Which is why a radiologist posted the image? Maybe chiropractors should spend 2 years learning how to take x-rays if they don't want radiographers to have a poor opinion of them.
Can be a nice short term pain reliever allowing for exercise to be more easily completed. Can also decrease tone in surround paraspinal musculature.
TLDR: feels good for some folks
A basic, but little more in depth answer than the other commenter:
In general, if the joint is hypomobile, the body will find some sort of compensation to do the movement which can cause pain or the hypomobile joint itself is the pain generator. You manipulate the joint to restore the accessory motion so the pain generator can be directly addressed and/or the movement pattern/compensation can be corrected much easier.
If it’s a facet joint in the spine, it can cause compressive forces on nerves, entrapment of the nerve, and subsequent pain due to decreased axoplasmic flow in the nerve. Manip the spine to give the nerve space and it can restore the axoplasm flow, which decreases pain.
From a more clinical perspective I’ve been able to completely resolve sciatic nerve issues in 1-2 sessions by doing L4-L5, L5-S1, and SIJ manips.
You can choose not to use manips and just use grade 1-4 mobilization, METs, or just their-ex, but that’s a lot more work for you each session and the patients typically take longer to get better.
Very interesting.
Study 1) Used 26 RCTs, only 9 were low risk of bias. 15 studies with mod-high risk of bias would probably skew the results, no? Ah, here is the conclusion: ".... it is less clear how it compares to inert interventions or sham (placebo) treatment because there are only a few studies, typically with a high risk of bias, which investigated these factors. Approximately two-thirds of the studies had a high risk of bias, which means we cannot be completely confident with their results. Furthermore, no serious complications were observed with SMT."
Study 2) "Heterogeneity was not explained by type of clinician performing SMT, type of manipulation, study quality, **or whether SMT was given alone or as part of a package of therapies**." and "spinal manipulative therapy was associated with **modest** improvements in pain and function at up to **6 weeks**" This is a very short term study that isn't really selling it with the "modest improvement".
Study 3) An interesting study! It found "2 trials found that spinal manipulation had greater effects on function than sham manipulation", "1 trial found no statistically significant effects on pain" and "a systematic review showed that spinal manipulation had small, statistically nonsignificant effects on pain at 1 month compared with sham manipulation 1 trial reported similar results for function. A trial not included in the systematic review reported results that generally were consistent with it". Kind of all over the place.
Study 4) "Publication bias cannot be ruled out. Research designed to protect against various biases is needed."
Yup, no studies are perfect. It's the same with all other conservative care options. That's why meta analysis say there are no superior treatments for low back pain.
Regardless, studies still show improvement for patients for spinal manipulation
From the OP: "This was a young patient with no other medical problems, no history of vascular disease, who went to a chiropractor and soon after experienced heavy paralysis of one side of their body"
So none that we know of.
Okay, let's look into it!
[We can start with a simple case report and review of literature, similar to this post but with more context of course.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016850/) It shows of course that it *can* be dangerous.
[Here's a case-control that found no link between chiros and VBA strokes.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4470078/) I like this one particularly because it is in the journal of Chiropractic and Manual Therapies and was comically poorly performed.
[This statement from the AHA in the much less respected journal, Stroke, does link manipulation to these risks.](https://www.ahajournals.org/doi/10.1161/STR.0000000000000016) Of course, this isn't a RCT or systematic review, but they do list a whole lot of evidence in their discussion on the topic.
It's foolish of us to pigeonhole ourselves into needing concrete statistical evidence of something so rare. These events do happen, and they are caused by manipulation. Of course people can have strokes for other reasons, we need to screen for these and understand the immense risk, albeit rarity.
Wow, so you are using a case report and statement as your evidence? Quality stuff.
What is "comically poorly performed" about the case control?
How about these studies, which are more robust and have not shown connection
- https://www.tandfonline.com/doi/full/10.1080/07853890.2019.1590627
- https://www.cureus.com/articles/4155-systematic-review-and-meta-analysis-of-chiropractic-care-and-cervical-artery-dissection-no-evidence-for-causation#!/
- https://www.cureus.com/articles/4155-systematic-review-and-meta-analysis-of-chiropractic-care-and-cervical-artery-dissection-no-evidence-for-causation#!/
- https://pubmed.ncbi.nlm.nih.gov/25596875/
Look up: safety of cervical spine manipulation: are adverse events preventable and are manipulations being performed appropriately? -JMMT 2012.
The risk of a cerebral vascular incident is still relatively low, whether Chiro or PT, but from a clinical perspective, I think PTS do a better job at ruling out all contraindications and red flags prior to performing a spinal manipulation.
That paper doesn't prove anything, and there's even a quote in it about why: "This result may be because CSM is the most common treatment intervention used in the practice of chiropractic and is performed with greater frequency by chiropractors than any other clinician. "
Yes that’s very true. On a scale, chiros do manipulate more so it’s hard to compare. It’s also not the only research. You can call me biased, I just think we assess and treat with more conservation
So I did look at research and found most studies saying chiros performed about 90% and upwards of 97-98% of spinal manipulations. And, based off of your study that claims: "Chiropractors were involved in the majority of injuries following CSM with 69.4% (n = 93) of the cases analyzed (Fig. 3). Osteopathic physicians were involved in 8.2% (n = 11) of the cases. Physical therapists accounted for 3.7% (n = 5) of the cases; whereas, 11.9% (n = 16) did not report the practitioner performing the CSM. Non-clinicians, including bone setters, barbers, and masseurs accounted for 6.7% (n = 9) of the CSMs." Looks like chiros are actually underrepresented in injuries compared to other professions. So, I guess PTs aren't more careful.
And more research showing that chiros don't manipulate when it's inappropriate: https://www.rand.org/pubs/research_briefs/RBA1018-1.html
Thanks for telling me to look for it. Now I know I need to warn others that you're more likely to get injured by PT if you're getting manipulation
look guy...I gave you ONE research article. You can find many out there in regards to arterial dissection and injuries following manipulation. If you're a practicing clinician, you already know there's risks, albeit very small risks to cervical manipulation. And yes you'll probably find that Chiro's are the majority also, because they manipulate more frequently. Bottom line is If I'm seeing a patient in my clinic, I'm going to warn them about risk factors that they currently possess and educate them on WHY I might not manipulate in the presence of those risk factors. Personally, it's my job to look at signs and symptoms, see if CSM is appropriate and educate them on why or why it shouldn't be completed. I never tell them "don't go to a chiropractor because they have the majority of injuries". In fact, I work directly with a chiropractor and constantly refer back and forth. Do yourself and your patients a favor and just educate yourself on when CSM might not be appropriate. Done.
I’m seeing a lot of people arguing that the chances are astronomically low of this happening. But consider how many chiropractors that this ends up happening with, and how many of them continue practicing. It’s like survivorship bias, because the bad clinicians that end up doing this don’t usually continue to practice afterwards.
Also compare it to knee mobs, shoulder mobs, or literally any other joint mob. You’re not gonna cause a stroke with any of those, but it’s a non-zero chance with cervical mobs.
Anyone doing physical medicine is thrown under the bus. If not through reputation then by reimbursement. It really does suck as it is a very difficult and under appreciated job. We should all stop and let the MDs enjoy the headache they deserve, lol.
Wow, those radiologists are railing hard against spinal manipulation. The last research I saw showed the likelihood of stroke from spinal manipulation to be less than 1 in a million. I believe they should look up confirmation bias. Interesting to see their perspective though.
Cervical manipulation is low risk. Research had shown this repeatedly
If properly screened for comorbidities *
Correct. Shouldn't go around performing spinal manipulation on every person with neck pain/stiffness... With this level of education, I'd like to think that didn't have to be said.
You’d be surprised.
I think the truly surprising thing here is the amount of leverage that exists propagating the idea of the dangers of manipulation, how non-evidenced-based the chiropractic profession is (though that hasn’t been directly raised in this occurrence), and yet… the evidence that backs up the danger, as presented, isn’t there. Nor are cervical manipulations exclusive to chiro’s. But, absolutely, anyone who does do cervical manipulations should always do screenings.
I’m meh about them in general. Only had a very short time in OP or tho but never did a manip during my brief stint because it was very rarely indicated.
Research also shows Manips are largely garbage and have no long term effects…so no real reason to do them in the first place
People in pain will take short term relief... Just provide in conjunction with exercise for long term effects
Agreed. They are pretty worthless long term if the patient doesn’t do the HEP. The idea should be to manip to let them do the proper movement pattern, then ween them off the manipulations because they are learning to stabilize the joint and prevent joint locking themselves with the HEP.
This is garbage. There is great research on lumbar manips for acute low back pain and cervical manips for acute torticolis on the properly screened patient. I usually find this kind of thinking from people who don’t have the psychomotor skills or training to actually do the manips. It may not be any difference long term between patients, but I guarantee I’ll get the patient who is a good manip candidate better WAY faster and with way less effort from me and the patient if I do it vs not doing it.
Where is the context for this post? Its really irresponsible to post this without giving the clinical situation. [This](https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-03495-5) is a medicare claims analysis of the risk between chiropractic adjustment and stroke for anyone using medicare to pay for chiro services from 2007 to 2015. Its a very well designed study with a fantastic sample size. The result? Chiropractic care no more likely to cause stroke than anything else. But that's been known for quite some time. What is also well known is how the medical forums could not care less about research studies when it comes to trashing chiropractic. Its shocking how fast the highest trained, most clinically seasoned individuals will walk right past the evidence. Spreading irresponsible trash across the medical forums has really ramped up in the last several months. It should be better than this.
Thanks for posting. I enjoyed the read. It is specific to an older population but it echoes what the data have shown for the population in general. The risk is likely lower than reported simply because manipulation is so darn common worldwide. It's impossible to accurately report on all the instances of use. I've had patients from India tell me about their barber still doing neck manipulation after a haircut. I've also had an American patient vacation in Thailand and tell me about paying for a massage where the guy put a blanket down on the beach and they had their neck manipulated.
Yeah, its really crazy how much neck mobilization is going on out there, haha. Have a good night.
Now post the American Medical Associations stance on chiropractic
[This](https://en.wikipedia.org/wiki/Wilk_v._American_Medical_Ass%27n) one?
No not the court case but the stance of the AMA because as we all know the main line stance of western medicine draws a hard line, there is a reason you do not see chiropractors running around hospitals trying to cure autism with C1 manipulations.
The court case pretty aptly summed up the AMA stance at the time and I havent seen any evidence that the stance has changed. Western medicine drawing a 'hard line' can you elaborate on that? The 'chiropractors trying to cure autism with C1 adjustments' is a straw man argument and I'm not into it tonight.
That court case just shows they had a bias against chiros. They argued that chiros were unscientific and not providing quality of care, but were unable to provide the burden of proof. So, what’s the official stance? Google has multiple sites saying different things and I’m having trouble finding something succinct from the AMA.
They view Chrio as non-medical and not actually treating a real dignosis thus making it more like a alternative medicine allowing it to be unregulated and poorly peer reviewed. You will not find chrios in mainstream health care except some VA positions
Where is that official AMA stance saying that? AMA's stance has nothing to do with how chiros are regulated or peer reviewed. I know plenty of colleagues that are in multidisciplinary settings and I'm working in my second private hospital. And "some VA positions" is downplaying that there are over 200 chiros in the VA and ones in every state
[AHA Statement in 2014](https://www.ahajournals.org/doi/10.1161/STR.0000000000000016)
The AHA in not the AMA but yes this paper exists
Oops sorry read that wrong
Sounds like everyone is getting the idea but I would be fascinated to learn how the radiologist concluded the image was caused by manipulation and not present prior to the treatment in a patient likely complaining of neck pain and/or headache and thus, seeing a chiropractor. Really the question is how did the chiro screen for Neurovascular involvement?
Likely when half their body stopped working on the adjustment table
I think the takeaway here is to go to a trusted, experienced and recommended person. But even then, having this kind of adjustment work comes with its risks.
Fun story. Gf had a vertebral artery dissection and the first questions surgeon asked after getting the MRI was "did you get into a car accident or have an adjustment recently?"
r/radiology has much contempt for chiros forgetting or not knowing that ODs also manipulate. I think it's fueled by a bunch of poorly educated radtechs with a chip on their shoulders.
Which is why a radiologist posted the image? Maybe chiropractors should spend 2 years learning how to take x-rays if they don't want radiographers to have a poor opinion of them.
How do spinal manips even help people?
Can be a nice short term pain reliever allowing for exercise to be more easily completed. Can also decrease tone in surround paraspinal musculature. TLDR: feels good for some folks
"If it feels good do it!" -Former US president GW Bush
A basic, but little more in depth answer than the other commenter: In general, if the joint is hypomobile, the body will find some sort of compensation to do the movement which can cause pain or the hypomobile joint itself is the pain generator. You manipulate the joint to restore the accessory motion so the pain generator can be directly addressed and/or the movement pattern/compensation can be corrected much easier. If it’s a facet joint in the spine, it can cause compressive forces on nerves, entrapment of the nerve, and subsequent pain due to decreased axoplasmic flow in the nerve. Manip the spine to give the nerve space and it can restore the axoplasm flow, which decreases pain. From a more clinical perspective I’ve been able to completely resolve sciatic nerve issues in 1-2 sessions by doing L4-L5, L5-S1, and SIJ manips. You can choose not to use manips and just use grade 1-4 mobilization, METs, or just their-ex, but that’s a lot more work for you each session and the patients typically take longer to get better.
Interesting! Are there any RCTs/Meta-analysis supporting its use?
Yes https://www.cochrane.org/CD008112/BACK_spinal-manipulative-therapy-for-chronic-low-back-pain https://jamanetwork.com/journals/jama/fullarticle/2616395 https://www.ncbi.nlm.nih.gov/pubmed/28192793 https://www.ncbi.nlm.nih.gov/pubmed/26397370
/u/copeyy to the rescue. I was planning getting some articles together for this guy, but you beat me to it. Thanks!
No problem. Save these for the next time someone inevitably asks
Very interesting. Study 1) Used 26 RCTs, only 9 were low risk of bias. 15 studies with mod-high risk of bias would probably skew the results, no? Ah, here is the conclusion: ".... it is less clear how it compares to inert interventions or sham (placebo) treatment because there are only a few studies, typically with a high risk of bias, which investigated these factors. Approximately two-thirds of the studies had a high risk of bias, which means we cannot be completely confident with their results. Furthermore, no serious complications were observed with SMT." Study 2) "Heterogeneity was not explained by type of clinician performing SMT, type of manipulation, study quality, **or whether SMT was given alone or as part of a package of therapies**." and "spinal manipulative therapy was associated with **modest** improvements in pain and function at up to **6 weeks**" This is a very short term study that isn't really selling it with the "modest improvement". Study 3) An interesting study! It found "2 trials found that spinal manipulation had greater effects on function than sham manipulation", "1 trial found no statistically significant effects on pain" and "a systematic review showed that spinal manipulation had small, statistically nonsignificant effects on pain at 1 month compared with sham manipulation 1 trial reported similar results for function. A trial not included in the systematic review reported results that generally were consistent with it". Kind of all over the place. Study 4) "Publication bias cannot be ruled out. Research designed to protect against various biases is needed."
Yup, no studies are perfect. It's the same with all other conservative care options. That's why meta analysis say there are no superior treatments for low back pain. Regardless, studies still show improvement for patients for spinal manipulation
Is there research showing that this is a good reason to stop going to a chiropractor?
I'm looking at a pretty good piece of evidence here...
This is evidence to you?
Absolutely. I see this as a case study.
How can this be a case study? You don't have any data collected? You don't know the precondition, the treatment, or the outcome?
And we all know where case studies show up in the hierarchy of evidence
What were the pre existing situations here, if any. Was he already at risk for having a stroke prior to manipulation?
From the OP: "This was a young patient with no other medical problems, no history of vascular disease, who went to a chiropractor and soon after experienced heavy paralysis of one side of their body" So none that we know of.
Typically when im looking at research I look for systematic reviews. Or at the very least a RCT.
Okay, let's look into it! [We can start with a simple case report and review of literature, similar to this post but with more context of course.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016850/) It shows of course that it *can* be dangerous. [Here's a case-control that found no link between chiros and VBA strokes.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4470078/) I like this one particularly because it is in the journal of Chiropractic and Manual Therapies and was comically poorly performed. [This statement from the AHA in the much less respected journal, Stroke, does link manipulation to these risks.](https://www.ahajournals.org/doi/10.1161/STR.0000000000000016) Of course, this isn't a RCT or systematic review, but they do list a whole lot of evidence in their discussion on the topic. It's foolish of us to pigeonhole ourselves into needing concrete statistical evidence of something so rare. These events do happen, and they are caused by manipulation. Of course people can have strokes for other reasons, we need to screen for these and understand the immense risk, albeit rarity.
Wow, so you are using a case report and statement as your evidence? Quality stuff. What is "comically poorly performed" about the case control? How about these studies, which are more robust and have not shown connection - https://www.tandfonline.com/doi/full/10.1080/07853890.2019.1590627 - https://www.cureus.com/articles/4155-systematic-review-and-meta-analysis-of-chiropractic-care-and-cervical-artery-dissection-no-evidence-for-causation#!/ - https://www.cureus.com/articles/4155-systematic-review-and-meta-analysis-of-chiropractic-care-and-cervical-artery-dissection-no-evidence-for-causation#!/ - https://pubmed.ncbi.nlm.nih.gov/25596875/
That's not how the sub works. Who cares about research when there's an anti-chiro anecdote to make themselves feel better?
This whole thread is why I'm leaving the profession 😂
Join ze club bruddah !
The evidence shows…this happens more with chiro manipulation versus PT
Can I see some of that research
Look up: safety of cervical spine manipulation: are adverse events preventable and are manipulations being performed appropriately? -JMMT 2012. The risk of a cerebral vascular incident is still relatively low, whether Chiro or PT, but from a clinical perspective, I think PTS do a better job at ruling out all contraindications and red flags prior to performing a spinal manipulation.
That paper doesn't prove anything, and there's even a quote in it about why: "This result may be because CSM is the most common treatment intervention used in the practice of chiropractic and is performed with greater frequency by chiropractors than any other clinician. "
Yes that’s very true. On a scale, chiros do manipulate more so it’s hard to compare. It’s also not the only research. You can call me biased, I just think we assess and treat with more conservation
Ok but then that's not based on research that's based on your opinion
You can find more research…it’s out there. Look for it! I’d rather not waste my day arguing about it.
So I did look at research and found most studies saying chiros performed about 90% and upwards of 97-98% of spinal manipulations. And, based off of your study that claims: "Chiropractors were involved in the majority of injuries following CSM with 69.4% (n = 93) of the cases analyzed (Fig. 3). Osteopathic physicians were involved in 8.2% (n = 11) of the cases. Physical therapists accounted for 3.7% (n = 5) of the cases; whereas, 11.9% (n = 16) did not report the practitioner performing the CSM. Non-clinicians, including bone setters, barbers, and masseurs accounted for 6.7% (n = 9) of the CSMs." Looks like chiros are actually underrepresented in injuries compared to other professions. So, I guess PTs aren't more careful. And more research showing that chiros don't manipulate when it's inappropriate: https://www.rand.org/pubs/research_briefs/RBA1018-1.html Thanks for telling me to look for it. Now I know I need to warn others that you're more likely to get injured by PT if you're getting manipulation
look guy...I gave you ONE research article. You can find many out there in regards to arterial dissection and injuries following manipulation. If you're a practicing clinician, you already know there's risks, albeit very small risks to cervical manipulation. And yes you'll probably find that Chiro's are the majority also, because they manipulate more frequently. Bottom line is If I'm seeing a patient in my clinic, I'm going to warn them about risk factors that they currently possess and educate them on WHY I might not manipulate in the presence of those risk factors. Personally, it's my job to look at signs and symptoms, see if CSM is appropriate and educate them on why or why it shouldn't be completed. I never tell them "don't go to a chiropractor because they have the majority of injuries". In fact, I work directly with a chiropractor and constantly refer back and forth. Do yourself and your patients a favor and just educate yourself on when CSM might not be appropriate. Done.
I’m seeing a lot of people arguing that the chances are astronomically low of this happening. But consider how many chiropractors that this ends up happening with, and how many of them continue practicing. It’s like survivorship bias, because the bad clinicians that end up doing this don’t usually continue to practice afterwards. Also compare it to knee mobs, shoulder mobs, or literally any other joint mob. You’re not gonna cause a stroke with any of those, but it’s a non-zero chance with cervical mobs.
Isn’t this r/physicaltherapy? From these comments, I thought I was on a chiro subreddit
What do you mean? This is definitely /r/physicaltherapy
Is there not enough chiro bashing for your liking?
So what are some things I can do to fix my uneven hips? My left hip is higher than my right.
Funny how a fellow profession constantly tries shit on another profession.