1B.5. Cervical manipulation and stroke: Where are we now?

The current understanding, based on the evidence to date, suggests that while there is a clear, though rare, temporal relationship between CMT and VADS, no plausible causal connection can be made. It appears that, as the most common initial symptom of vertebral artery dissection is neck pain and headache, there are instances in which a patient who has these symptoms, without obvious manifestation of stroke, consults a chiropractor for the neck pain and headache, and subsequent to this experiences a full stroke, independent of anything that the chiropractor does or does not do. This current understanding has changed the responsibility of the practitioner from one of “screening” to one of diagnosis and public health education.