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A near-fatal consequence of chiropractor massage: massive stroke from carotid arterial dissection and bilateral vertebral arterial oedema
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  • Published on:
    • Dan Xu, General Medical Practitioner & Medical Educator 1 Curtin Medical School, Curtin University, Perth, Australia; 2 The First Affiliated Hospital, Sun Yat-sen University, Guangzhou

    Dear Sir/Madam.

    Thanks for your interest in our case report and the literature review on CeAD and spinal manipulation, which is the most important element of patient care.
    All clinicians would like to have a positive outcome for their patients using evidence-based practice.
    Unfortunately, the patient in this case had a near fatal outcome by a chiropractor practising in a major metropolitan region of China. The chiropractor is a graduate of a traditional Chinese medical university. The patient could only recall heavy massage and possibly using an equipment (activator? we did not put in the paper because of the uncertainty).
    The side effect with this mode of chiropractor treatment is extremely rare as what we have reviewed. This mode of treatment can certainly be the risk factors for the outcome (we ruled out most of the other risk factors presented in our case). We are sharing this case purely for education purpose without the intention of criticising any individual and the chiropractor profession. We did not want to see any more similar cases with an almost fatal outcome. We do appreciate that the whole profession of chiropractors constantly reviews their practice to ensure the delivery of evidence-based practice for treatment effectiveness of various aches and pain (shoulder girdle and neck pain in our case), which all health professionals should practice routinely.

    Hope the response helps to clarify the queries.

    kind regards


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    Conflict of Interest:
    None declared.
  • Published on:
    Misrepresentation of chiropractic in a case of carotid artery dissection
    • Lindsay R Rae, Chiropractor VA Finger Lakes Health Care System
    • Other Contributors:
      • Clinton J Daniels, Chiropractor
      • Robert J Trager, Chiropractor

    We read with interest the case report by Yap et al regarding “A near-fatal consequence of chiropractor massage: massive stroke from carotid arterial dissection and vertebral arterial oedema,”(1) which describes a 35-year-old man with a massive stroke purportedly caused by massage. Cerebrovascular disease is an invested topic for manual therapists, considering such providers are responsible for recognizing emergent signs/symptoms of a cervical artery dissection (CeAD) and referring accordingly,(2) however, we are concerned about appropriate and accurate reporting of details of the case including several inconsistencies and evident biases.

    We believe this case report likely misclassifies the treating provider as a chiropractor. The report does not specify the credentials of the person providing massage during the business trip. As pointed out by the authors, there is limited regulation and licensing of chiropractic in China.(3) Furthermore, spinal manipulation is by far the most common treatment intervention provided by chiropractors(4) but the authors did not mention its use in the case presentation.

    We request the authors clarify the credentials of the massage provider, and elaborate on treatment interventions, specifically if cervical spinal manipulation was performed. Previous case reports have misrepresented the treating provider as a chiropractor when describing potential adverse events.(5) This practice is spurious and adds to over-reporting of adverse...

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    Conflict of Interest:
    None declared.