How Safe Is Your Technique?
PERSPECTIVE
The following is an actual event that occurred in a chiropractor ’s office, of which I have both a personal and business relationship. I asked the chiropractor ’s permission to share his story in an attempt to remove some of the falsehoods surrounding techniques that many of y ou have and share.
Stuart Hoffman
Unfortunately, what I am about to share with you happens in chiropractors’ offices every day. It could happen in your office tomorrow. It doesn’t matter if you are an Activator practitioner, a Gonstead practitioner, an upper cervical practitioner, or use any type of instrument or soft tissue technique.
How risky is the technique you use in your office?
For the sake of the story, I’ll call this doctor, Dr. Thorough. Why Dr. Thorough? Simply because he is the most thorough practitioner I have ever known. In fact, besides having achieved diplomates in both neurology and exercise rehab and having about twenty-something years of practice under his belt, he was also an IME and a chiropractic expert witness with much experience in deposition and trial. His examination skills were second to none, and for every patient that came to his office, he did a complete orthopedic and neurological exam, checked blood pressure and pulse oximetry, as well as a 12-lead ECG and a Doppler to check the patency of the arteries before he would ever do a cervical adjustment on a patient. He was thorough to the point of being neurotic.
About seventeen years ago, Dr. Thorough had just moved to a rural community where he and his wife had always vacationed and wanted to live. Prior to his moving, he had a six-month waiting list practice, which included many referrals from other
“We have found in medical literature more than 72 simple, everyday movements are known causes of vertebral artery
dissection. 5 5
chiropractors and medical professionals. Once relocated, he wasn’t sure whether he wanted to work at another chiropractor’s facility or open his own office again, and he was going to take a few months to decide.
As fate would have it, a number of people in the community had heai d about his reputation and started to get in touch with him to see if they could become his patients. In fact, Canyon Ranch had contacted him to be paid of their Pain Management Center, and even the local hospital got in touch with him to become paid of their community outreach program. Now the decision was made for him. He would open a home office just to accommodate die patient demand.
Unbeknownst to him at the time, a mother and daughter who had gone to his previous office right outside of Washington, DC for about ten years had also moved to the area and got in touch with him to come in to see him.
It was late Friday afternoon. His visiting in-laws had just arrived and were in the house waiting for Dr. Thorough to finish seeing the mom and daughter when it all came unhinged.
Dr. Thorough ran from the treatment room to the kitchen with his heaid pounding, he picked up the phone and called 911 to inform them that a woman in his office was having a stroke. He didn’t hesitate to make the call because he knew the signs, and he kept monitoring the neurological and vital signs of the mom so that he could report to the EMTs as soon as they arrived. Of course, they came blazing sirens and all.
The downside of living and practicing in a rural community is that a lot of people monitor the police radio band, so it was only minutes before everyone in this little town heaid that a woman in Dr. Thorough’s chiropractic office was having a stroke.
When the EMTs arrived, Dr. Thorough immediately presented all of the woman’s vitals and neurological signs, and then they took over, placed her on the stretcher, and took her to the hospital. Fortunately, the patient had a complete recovery thanks to the immediate action of Dr. Thorough. The rest of the town and Dr. Thorough’s in-laws did not recover so quickly.
So what went wrong that caused this event? How did a doctor, whose skills were second to none, wind up in this situation? Was the technique he used and had been using for more than twenty years a high-risk technique that eventually caught up with him?
If you aie sitting there wondering what technique this doctor used (and maybe if it is the technique you use) that caused the stroke,
then you need to take a moment and think about a few things.
As my good friend Dr. Gerry Clum has stated, “Of those 3,000 cases that occur in the United States of vertebral artery dissection annually, a very, very few, perhaps a handful, aie associated with chiropractic care either on a temporal or a causative basis.”
He went on to say, “This is an important perspective for us to understand. As chiropractors, we are acutely attuned to this circumstance. When we hear a discussion of vertebral artery dissection, we automatically make a mental tie to, ‘Was an adjustment paid of the picture, etc.?’ The reality is, in the vast, vast majority of cases, a chiropractor wasn’t anywhere in sight, wasn’t anywhere paid of this patient’s life and times.”
Through the research that ChiroSecure has conducted with our partners, we have found in medical literature more than 72 simple, everyday movements aie known causes ofveidebral artery dissection. Some of these include yoga, painting a ceiling, nosebleeds, hypertension, sexual activity, receiving anesthesia, receiving a shampoo, vomiting, sneezing, and also doing nothing at all. Some of these are just brought on without any known cause whatsoever. Understanding all of that, let me ask you the same question I asked at the beginning. How risky is the technique you use in your office?
A more important question might be, do you believe that one chiropractic technique is riskier than any other, or less risky for that matter? Do you believe Activator is safer to use than a Gonstead cervical chair adjustment or any other technique?
Write this down: There is no sound scientific evidence, no epidemiologic study, no biomechanical study that proves a causative link between chiropractic manipulative therapy and vertebral artery dissection.
In other words, the current thinking is that, to a greater or lesser extent, many of these patients walk into your office or any office in the process of dissection, with the dissection itself producing neck pain and headache, and as a result, they consult the chiropractor. In other words, a significant percentage of people who develop vertebral artery dissection in relationship to chiropractic care had the dissection when they presented for care.
Most doctors and their techniques aie not
the issue. What most doctors aie guilty of has nothing to do with their adjusting technique. Most aie simply guilty of bad timing when a patient already in the throes of an arterial dissection visits their office, and their inability to recognize it.
Let’s get back to Dr. Thorough. What technique did he use that brought this about?
Would it really matter? Based on the evidence, chances aie that this woman was already in the process of arterial dissection when she presented to his office? In fact, that was exactly the case in this situation.
The truth is, the woman who had a stroke in his office was not, nor ever was, a patient of Dr. Thorough’s. I never mentioned
■ ■ What most doctors are guilty of has nothing to do with their adjusting technique. Most are simply guilty of bad timing when a patient already in the throes of an arterial dissection visits their office, and their inability to recognize it. ï Ï
that she was actually a patient when telling the story. As always, she had visited his office every time her daughter was adjusted. Although Dr. Thorough always tried to get her under his care, she never did and just happened to be sitting in the room watching her daughter get adjusted when her stroke occurred.
So what was the point of this article if you haven’t figured this out already?
Chances aie you believe that the technique you use puts you at a greater or lesser risk than any other doctor. If that is the case, you still believe, just as the public does, that a chiropractic adjustment can cause a stroke. There is no evidence to support that belief.
The good news is that we do not deal in beliefs at ChiroSecure. We deal in facts. The facts aie that the technique you use has
little to do with whether you aie at a greater risk or lower risk, especially if you master the ait of whatever technique you use, which we highly recommend.
As a result, ChiroSecure has dedicated itself to make sure that if a patient alleges that a chiropractic adjustment has caused an arterial dissection, the most aggressive defense available based on research will be asserted.
Changing public opinion of chiropractic is a critical issue and the best place to start is dispelling some of the myths that surround what we do both publicly and within the profession itself.
Dr. Stuart Hoffman has been honored asICA ’s Chiropractor of the Year for 2015 and was previously awarded Chiropractor of the Year from the Michigan Council. He has also been recognized by Life University President Dr Guy Riekeman for his success, leadership, and vision through his contributions supporting the mission of the President ’s Circle. He is a successful 35-year practitioner who owned and operated 14 chiropractic
offices and employed many associate DCs. For the past 25 years, he has served asfounder as well as owner and operator of ChiroSecure, a malpractice insurance company that he personally spearheaded to become the second largest program in that market. His expertise and love for chiropractic allow him to stay on the cutting edge of risk management and continue to be one of the most sought after speakers in the chiropractic profession by state associations throughout the country, as well as a favorite at the chiropractic college campuses. For a copy of his highly recommended and regarded Informed Consent Packet, text the word TECHNIQUE to 480-500-6574.
