Why does research matter to you? Dr. Lou Sportelli explains how one research project impacted the practice of every DC in business today.
Posted in Examiner eNewsletter on Wednesday, March 10, 2021
You may not be aware of it by name, but a single research project with roots in the '90s has changed the course of every chiropractic practitioner’s clinical practice. This research project:
- Improved clinical understanding
- Provided a solid defense in litigation
- Altered attitudes of all but the most biased in the research community
- Withstood scrutiny and provided an understanding of facts only achievable through solid, first-rate research
Scare Tactics Against Chiropractic
Before I do, consider the images that have appeared in the media in recent years: A transit bus roaming the streets of a major U.S. city with the headline: “Injured by a Chiropractor – Call 1-800 Chiropractic Stroke Victims Awareness Group.” A billboard with the alarming notice: “Warning: Chiropractic Adjustments Can Kill or Permanently Disable You.” As recently as the 1990s, scare tactics like these that alleged chiropractors caused strokes were rampant. The infamous Lana Lewis case caused untold harm to the profession, because at the time, there was no credible evidence to dispute a causal connection between a chiropractic cervical spine adjustment and a patient having a vertebral artery dissection. Consequently, the move to ban chiropractic cervical adjustments gained momentum.
Formation of the Neck Pain Task Force
For the clinician in private practice, there was little to no literature to provide guidance. At the time, one test commonly thought to provide a viable screening was the George’s Test. Early research findings would determine this test was invalid and potentially could cause harm. All chiropractic colleges universally discontinued teaching the George’s Test and disseminating this information, and many groups and associations undertook a massive effort to transition away from using the test. In the late 1990s, these developments led Dr. Scott Haldeman, a DC, MD, and practicing neurologist, to undertake the formation of a Neck Pain Task Force in conjunction with the launch of the Bone and Joint Decade.
From a clinical perspective, the Neck Pain Task Force research literally changed the manner of how chiropractors practice. There was new understanding of adverse stroke events, improved clinical understanding of what could and could not be detected in asymptomatic patients and a heightened awareness of the factors involved in these rare events.
This research changed the course of clinical practice because it revealed:
- There is simply no way to determine beforehand which offending mechanical neck movement or manipulation type would precipitate an artery dissection. Manipulation is safe, effective and appropriate for most patients with disabling neck pain.
- The risk of vertebrobasilar artery stroke (VBA) is rare, and the risk for neck patients is the same whether they consult a chiropractor or a medical physician.
- Eighty percent of stroke patients had neck pain from an artery dissection in the days before their stroke, which led them to seek health care services from a DC or MD.
- Patients often describe a headache unlike any they have experienced before as a clinical difference during a VBA.
The exhaustive Neck Pain Task Force research found no evidence of a causal link between chiropractic care and cervical artery dissection. However, it did provide a clear link between research findings and an evidence-based clinical practice. Field doctors should be aware of ongoing research into the cervical spine, lumbar spine, brain plasticity and concussion injuries.
What’s more, a host of current research seeks to uncover underlying issues and new approaches clinicians can incorporate into their practices. Although there are many research findings that impact a clinical practice, in my view, the stroke phenomenon is one of the best examples. A chiropractor’s clinical practice, clinical awareness, clinical judgment and clinical competence have all been directly affected by stroke research.
As we look to the future, I believe every clinical practice will be directly impacted by research and technology to make health care a safer and more effective clinical experience. mechanical neck movement or manipulation type would precipitate an artery dissection. Manipulation is safe, effective and appropriate for most patients with disabling neck pain.