Ensuring Safety in Chiropractic Care: Qualifications, Risks, and Prevention

Chiropractic care is a widely used, evidence-based approach to musculoskeletal health, particularly for spinal conditions. While generally safe, concerns regarding high-velocity neck manipulations have been raised, particularly following a recent tragic incident in Thailand. This article explores the safety of chiropractic care, the extensive training chiropractors undergo, the incidence of vertebral artery dissection (VAD), and measures to prevent injuries.

Chiropractic Training and Qualifications in New Zealand

In New Zealand, chiropractors undergo rigorous education and training to ensure patient safety. The New Zealand College of Chiropractic (NZCC) offers a five-year program, which includes:

• 4,800+ hours of academic and clinical training.
• Extensive coursework in anatomy, neurology, radiology, biomechanics, and chiropractic techniques.
• Clinical internships under licensed practitioners to develop hands-on expertise.

Upon graduation, chiropractors must be registered with the New Zealand Chiropractic Board, which enforces stringent professional and ethical standards.

Understanding Vertebral Artery Dissection (VAD) and Chiropractic Care

Vertebral artery dissection (VAD) is a rare but serious condition where a tear in the vertebral artery can lead to a stroke. Some case reports have linked VAD to chiropractic neck adjustments, raising concerns about the safety of spinal manipulation. However, research suggests that the incidence of VAD associated with chiropractic care is extremely low:

• A study published in Spine (2008) found no direct causation between chiropractic adjustments and VAD.
• A 2016 study in the Journal of Stroke and Cerebrovascular Diseases concluded that individuals with VAD were just as likely to have visited a general practitioner as a chiropractor prior to the event.
• The overall risk of VAD from neck manipulation is estimated at 1 in 1-2 million adjustments, according to research in the Journal of Neurology (2002).

Preventing Injuries in Chiropractic Practice

To ensure patient safety, qualified chiropractors follow strict protocols when performing spinal adjustments:

1. Comprehensive Patient Screening:
   • Evaluating medical history to identify contraindications (e.g., vascular conditions, connective tissue disorders).
   • Performing neurological and orthopedic assessments before any high-velocity cervical manipulation.
2. Informed Consent:
   • Patients are provided with clear information about the risks and benefits of chiropractic care.
   • Alternative treatment options are discussed when necessary.
3. Modified Techniques for High-Risk Individuals:
   • Low-force techniques, mobilizations, or soft tissue therapy are recommended for patients with higher stroke risks.
4. Professional Regulations and Continuing Education:
   • Chiropractors in New Zealand are required to undertake continuing professional development (CPD) to stay updated on best practices and patient safety guidelines.

Lessons from the Thailand Incident

The recent death in Thailand due to cervical manipulation highlights the importance of seeking care from properly trained and licensed practitioners. Key takeaways include:

• Always verify a chiropractor’s qualifications and registration.
• Avoid treatment from unlicensed individuals claiming to perform chiropractic adjustments.
• Be aware of symptoms such as dizziness, vision disturbances, or severe headaches post-adjustment, and seek medical attention if they occur.

Final Thoughts

Chiropractic care remains a safe and effective treatment for many musculoskeletal conditions when performed by a qualified, well-trained practitioner. While risks such as VAD exist, they are exceedingly rare and can be mitigated through proper patient screening and adherence to safety protocols. If you are considering chiropractic care, ensure that your practitioner is licensed, experienced, and follows best practices to prioritise your health and safety.