The chiropractic profession has been serving the health needs of millions of people around the world for nearly 110 years. The benefits of spinal manipulative procedures have proven to be of clinical benefit for neuromusculoskeletal conditions affecting patients of all ages. While the benefits of spinal manipulative procedures continue to be researched and grow in acceptance throughout the scientific and clinical worlds, there are still some matters of controversy surrounding this time-honored therapeutic procedure.
One issue that has garnered a great deal of attention from the media and the profession's critics, particularly in recent months, is the association between stroke/CVA and manipulative procedures performed to the cervical spine. The critics have taken a very remote risk of vertebral artery dissection (VAD), and have disproportionately magnified the "fear factor" in the general population.
It is estimated that more than 300 million cervical adjustments are performed each year in the United States. The risk of a VAD is estimated to be at most 1.0-1.5 per 100,000 people, which is considered a very rare occurrence. Individual doctors of chiropractic and chiropractic educational institutions have also voiced concerns about how to inform practitioners of the potential risks and provide the best information to the patients they serve.
CEvantive.com, an online continuing education university, has created a two-hour course titled "Stroke and Cervical Manipulation." The course outlines the most salient clinical facts associated with this subject, and tries to debunk many myths that currently face practitioners. Provided free of cost directly from the Web site (www.cevantive. com), this course is expected to help produce homogenous thought among doctors of chiropractic and provide the most up-to-date information on this subject.
Several chiropractic organizations have already endorsed the program, with some making it mandatory for their members:
NCMIC - "The Stroke & Cervical Manipulation program has been made possible through the generous donation of CEvantive.com. This program is available to every doctor of chiropractic at NO COST. Their goal is to make this program available to every practitioner, researcher and educator by providing the latest information on STROKE and manipulation. Through this personal educational tool, the DC can take this very rare occurrence of vertebral dissection and truly understand the mechanisms of action, as well as the clinical manifestations and practical 'clinical pearls' to utilize in his or her practice immediately. NCMIC is proud to endorse the CEvantive Stroke & Cervical Manipulation program and encourages each and every DC to take immediate advantage of this unique offer."
National Chiropractic Council - "We have endorsed this program and believe that it could not have come at a more opportune moment. At a time when the enemies of the chiropractic profession are using the issue of cervical manipulation and stroke as a weapon to exclude chiropractic from compensation systems and to attack practice rights, this is a proactive way of showing that the chiropractic profession is minimizing the already extremely remote risk of stroke to the greatest extent possible."
Triad Health Care - "Triad Health Care, Inc., recognizes the seriousness of those rare cases of stroke being associated with spinal manipulation. Although this complication is quite rare, Triad Health Care will require all of its member chiropractors to complete the on-line instructional course on stroke and manipulation provided at CEvantive.com. Up-to-date instruction is always desirable and improves the quality of health care to our patients."
Pi Omega Delta Chiropractic Malpractice Program - "The two hour, free on-line course on 'Stroke & Cervical Manipulation' at CEvantive University is going to be a required part of coverage in our California Chiropractic Malpractice Program. Avoidance or elimination of these cases is probably not possible, (albeit small in occurrence percentages), but controlling the outcome, should one occur, is the responsibility of every doctor to his patient, and this quick study is a great tool in accomplishing that goal."
Peter Werth, president of the Chiropractic and Osteopathic College of Australia, notes: "COCA, having been a keen advocate of risk management in the Australian setting, applauds the initiative of providing all practitioners access to the necessary resources and training to educate and address the VBI issue."
While the course can be taken free of charge, another option is available to chiropractic practitioners around the world. If your state, province or territory accepts this course for continuing education (please refer to CEvantive.com's site map and list of approved curriculum), this two-hour course can be taken for as little as $50 (U.S.). The net proceeds from taking the course will be donated to the Foundation for Chiropractic Education and Research (FCER). Continuing education credit is obtained through Western States College of Chiropractic (WSCC). After a doctor completes the two hours of required course work, WSCC's postgraduate department will automatically be notified; within seven to 10 days, a certificate of completion will be mailed out.
