From the Guidelines
Chiropractic manipulation of the neck, particularly high-velocity, low-amplitude (HVLA) thrust techniques, can cause vertebral artery dissection leading to stroke in pregnant women, and therefore, should be avoided in this population. The risk of stroke is greatest when forceful rotation and extension of the neck are combined, which may stretch or tear the vertebral artery walls 1. Pregnant women may be at increased risk due to hormonal changes that increase ligament laxity and vascular changes including increased blood volume and altered vessel elasticity.
Key Considerations
- The scenario of greatest concern involves a pregnant patient receiving aggressive cervical manipulation, especially if she has pre-existing risk factors such as hypertension, vascular disorders, or previous history of migraines.
- Vertebral artery dissection can lead to blood clot formation, which may travel to the brain causing an ischemic stroke.
- Symptoms following such an injury might include severe headache, dizziness, difficulty speaking, or weakness on one side of the body.
- Many experts advise patients who experience a cervical arterial dissection to avoid activities that may cause sudden or excessive rotation or extension of the neck, such as contact sports, activities that cause hyperextension of the neck, weight lifting, labor in childbirth, strenuous exercise, and chiropractic manipulation of the neck 1.
Recommendations for Pregnant Women
- Pregnant women seeking chiropractic care should discuss gentler alternative techniques with their provider.
- Ensure their chiropractor is aware of their pregnancy and any risk factors.
- Avoid HVLA thrust techniques, especially those involving forceful rotation and extension of the neck.
- Be aware of the symptoms of vertebral artery dissection and seek immediate medical attention if they occur.
From the Research
Scenario and Technique
- A chiropractor can cause a stroke in a pregnant woman through chiropractic cervical manipulation, which involves high velocity thrusts that can produce significant strain on carotid and vertebral vessels 2, 3, 4.
- The technique used in cervical manipulation can lead to vertebral artery dissection or internal carotid artery dissection, resulting in ischemic stroke 3, 4.
- The risk of stroke is increased when excess physical force is used during chiropractic manipulation 4.
Risk Factors and Patient Profile
- Patients who are at risk for stroke after chiropractic manipulation may not be identified a priori, and neurological deficits can be severely disabling and potentially life-threatening 3.
- Pregnant women may be at increased risk due to physiological changes that can affect blood vessels and increase the risk of dissection 2.
- Patients with a history of head and/or neck pain, or those who experience sudden onset of new and unusual headache and neck pain, may be at higher risk of dissection and stroke 5.