Stroke Resources for Chiropractic Offices


AS A RESULT OF MEDIA COVERAGE, some patients may come into the offices of doctors of chiropractic (DCs) concerned about having their necks adjusted. The media at times publishes sensationalized articles promoting the myth that neck manipulation is a major cause of stroke. To address sensationalized media coverage, ACA has put together resources to help DCs explain the issue to patients. A great place to start is an article in the May 2014 issue of ACA News, “Evidence in Action: Responding to Chiropractors Cause Stroke,” on Page 34 or online at

This excellent article compiles the evidence for you to use as an easy reference. The research will enable you to clearly explain the remote association between vertebral artery dissection and cervical manipulation. The most well-known research by Cassidy is presented:

“Cassidy et al. discovered patients were 1.4 times more likely to have visited a DC in the 30 days preceding CAD stroke diagnosis. Additionally, this study discovered patients were just as likely to have visited a primary care physician (PCP) in the 30 days prior to being diagnosed with a stroke.”

To help DCs talk to their patients, ACA’s stroke resources web page features more research studies that demonstrate the safety of chiropractic, related articles, patient fact sheets and links to other educational tools. Key messages are also available that can help doctors touch on important facts during their discussions with patients. These resources are at

Included there are:

Comparison of Benefits/Risks Associated With CMT versus Other Treatments

This comprehensive information gives doctors a point of comparison about all major neck pain treatments, showing that, compared with the other treatments, neck manipulation is far safer.

Informed Consent

Informed consent is an important issue when discussing the stroke issue with patients. The ACA code of ethics, which new members agree to follow when they join ACA, notes that “doctors of chiropractic should employ their best good faith efforts to provide information and facilitate understanding to enable the patient to make an informed choice in regard to proposed chiropractic treatment. The patient should make his or her own determination on such treatment.” Such shared decision-making is key here.

Because informed consent is a key factor, ACA’s website shows its informed consent policy and a list of state statutes, legislation and legal precedents related to the issue. These resources are available at

Knowing the informed consent rules in the state in which you practice is necessary as they vary. ACA has posted a link to a summary of the state rules, laws and legal precedents.

Stroke Awareness

Of course all DCs should familiarize themselves with the warning signs of stroke. The American Stroke Association and the American Heart Association promotes the use of “FAST.” FAST stands for the warning signs of stroke in an easy-to-remember acronym:

  • Face Drooping – Does one side of the face droop or is it numb?
    Ask the person to smile. Is the person’s smile uneven? 
  • Arm Weakness – Is one arm weak or numb? 
    Ask the person to raise both arms. Does one arm drift downward?  
  • Speech Difficulty – Is speech slurred? Is the person unable to speak or hard to understand?
    Ask a person to repeat a simple sentence like, “The sky is blue.” Is the sentence repeated correctly? 
  • Time to Call 911 – If someone shows any of these sympoms, even if the symptoms go away, call 9-1-1 and get the person to the hospital immediately. Check the time so you’ll know when the first symptoms appeared.

Free Webinar: Chiropractic In-Office Emergency Protocols

This course highlights procedures to follow in the rare case that a patient walks into your office and exhibits signs/symptoms of an acute stroke. To register and take this FREE online course go to


1 Cassidy JD, Boyle E, Côté P, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine. 2008 Feb 15;33(4 Suppl):S176-83.

Dealing With the Media: ACA Spokespersons Available

ACA’s media spokespeople are well prepared to answer questions regarding the association of serious injury following cervical manipulation or the practice of informed consent. Refer any media inquiries to our PR team:

Talking to Patients

ACA provides patient handouts that doctors of chiropractic can print in their offices. These include the following Patient Education Pages:


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