Chiropractic iatrogenic illness

Chiropractic iatrogenic illness profiles some adverse effects of treatment.

It's sheer nonsense to suggest that there is no doctor caused disease in our clinics. However, whilst the reality is that serious injuries are rare, small and some not so minor problems are not uncommon.

How do I know? I have caused them myself, and regularly get questions from patients who have been injured by chiropractors. 

The majority of such injuries are self limiting, but some indeed are more serious. This page invites frank admissions from chiropractors in the field that would be beneficial to the whole community to even further minimise such problems. I include here some of my own mistakes.

If you have been seriously injured by a chiropractor, you may also make a submission at the bottom of this page.

I retain the right to edit all comments.

This morning:

Chiropractic iatrogenic illness

Chiropractic iatrogenic illness invites doctors and patients to share painful experiences.

Tiredness and fatigue

In research done in the Netherlands (published in Spine 2008; 33(13): 1451-1458), Dr Sidney Rubenstein DC, PhD, discovered that a significant number of patients experienced profound weariness after their first Chiropractic consultation for neck pain treatment.

It was not clear whether this was due to the Chiropractic treatment per se, or from the long process of taking a history, doing an examination, and sometimes giving the first treatment.

The history itself often is filled with emotion-rich content. Revisiting serious trauma, car accidents, falls off horses, physical beatings...

This "vermoeidheid" was largely limited to the first consultation, and was of a temporary nature.

Stiffness and discomfort

Stiffness and discomfort and sometimes mild pain of a temporary nature were common.

In the treatment of over 500 patients there were no serious adverse chiropractic iatrogenic illness events.

Fifty percent of the patients had less than half the pain by the fourth consultation.

Probably the most significant finding, is that the length of time that the patient had the neck pain was the best predicator of a successful outcome. Research indicates that a neck pain event of more than three months duration will probably never pass over completely, no matter what the treatment.

Cracked ribs

Probably the most common significant Chiropractic Iatrogenic Illness has to do with the rib cage. The ribs themselves (particularly in the elderly), and both the costo-sternal and costo-transverse joints can be injured by overly robust manipulation; most chiropractors will admit to at least a few bruised or cracked ribs.

In 30 years in practice, I recall five cases of fairly severe rib injury:

• LUMBAR ROLL

Whilst adjusting the lumbar spine of an elderly woman, my indifferent hand placed over the rib cage in the mid axillary line, cracked a rib. She had fairly intense pain with breathing for 3 days, and discomfort thereafter for several weeks.

SOLUTION: I now never place my hand directly on the rib cage. Rather I take a broader contact on the patient's hand or arm. I have never had a recurrence of this injury since changing my indifferent hand contact.

• CROSSED BILATERAL PISIFORM

I have personally never cracked a rib using this technique, but it is reputed that Chiropractors fairly frequently do.

However, I have several times set up a costo-sternal syndrome ( Tietzes syndrome ) using this technique.

SOLUTION:

Stay close to the spine (on the transverse processes) when adjusting the spine of elderly osteoporotic women. Only thrust on full expiration, and with a minimum of "brute force and ignorance".

Do not use PA techniques (or with a minimum of power) on patients complaining of sternal-rib pain. TIETZES SYNDROME ... costo-sternal chondritis.

• SITTING FIST EXTENSION

Using one of my favourite techniques for adjusting the thoraco-lumbar junction, I once squeezed too hard on the rib cage, and cracked a rib in the MAL. A bunch of flowers, and nice card and she returned for care after a few weeks.

• STRAIGHT BILATERAL THENAR

Probably the worst chiropractic iatrogenic illness rib injury that I have caused was adjusting an elderly lady for a Maignes syndrome radiating to the buttock and groin. The prone thrust on the first lumbar vertebra fractured several ribs in the anterior rib cage. She had quite severe pain for two weeks, and discomfort for a full one and half months. Patients are sometimes too kind; she accepted my sincere apology, together with free treatment until the pinched superior cluneal nerves passed; what's more she continued to consult me.

It was however a foolishness on my part; far too much force for an elderly patient. But she recovered completely with just some simple kinesiotaping of the ribs. 

Let's be honest. Experiences like this occur to every chiropractor sooner or later, if she or he uses manual adjustments of the spinal joints. Because of the propensity for North Americans to sue their doctors for injuries like this, some very gentle treatments have evolved that are unable to injure the patient; but they are also a lot less effective in my opinion.

The chiropractic of the Palmers, Janses, Gonsteads and Thompsons all have their iatrogenic illness risks.

Vertigo

A very large study done in the United Kingdom on the Chiropractic Iatrogenic Illness effects of neck manipulation found that a patient complaining of dizziness or vertigo was a predicator of a less than good outcome.

This creates a dilemma for the Chiropractor, as some patients with Vertigo respond well to gentle neck adjusting. However others apparently not so.

The presence of a positive Hallpike Dix test suggests that the patient should first be treated with the Epley manoeuvres before any adjusting of the cervical spine is considered.

ASIDE: I NEVER adjust the neck and do the Epleys at the same consultation. I once had a patient react extremely badly, with emesis for several hours. It passed, and she returned to treatment from a colleague. I was not forgiven for the mishap.

"I'm still learning."

- said by Michelangelo, aged 85.

Stroke

Stroke in the setting of chiropractic iatrogenic illness cannot be denied, but it is rare and accusations often spurious. One chiropractor was accused of having caused a CVA but eventually it emerged he only adjusted her foot. Another occurred some three weeks after the manipulation

A task force set up by the WHO to evaluate the prevalence of Stroke after a chiropractic consultation concluded:

VBA stroke is a very rare event and that the risk of VBA stroke associated with a visit to a chiropractor’s office appears to be no different from the risk of VBA stroke following a visit to a family physician’s office.

Depending on whose research you read it appears that Chiropractic Stroke occurs about once per 2-6 million cervical manipulations. There is thus an EXTREMELY LOW RISK of stroke a chiropractic neck adjustment. Far safer than swallowing an aspirin.

Litigation

It's indeed a fine line that separates an honest mistake from negligence. Despite the injuries listed above - they certainly can be construed at Chiropractic Iatrogenic Illness (or doctor-caused disease) I have never been sued.

Why? First, because I have a good relationship with my patients and when something goes awry I don't conceal the obvious but eat a humble pie. Patients are forgiving...

Secondly, I don't practise in North America. The American practice of suing doctors every time something goes wrong can only have a negative impact on society. Indirectly patients themselves, and society as a whole, have to pay for the astronomic insurance premiums that all doctors have to pay to cover their butts.

I once treated a Canadian woman who had a routine neck problem. I think I'm a relatively gentle chiropractor (judging by others I have watched), but I was astonished that she told me that five Canadian chiropractors had treated her so gently that the problem did not improve. Three or four good solid cervical adjustments and her problem was history.

Who suffers when society scares the wits out of it's doctors? That society. Who benefits when doctors are hauled before the courts for a minor mishap?

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