The Australian Chiropractor’s Association gave me the opportunity to talk to Kim Lie Jom about chiropractic and stroke. The “Elephant in the Room” conversation that needs to be heard.


There has been an unsubstantiated belief in a causal link between chiropractic neck manipulation and cervical artery dissection (CAD) that has had significant negative consequences for the profession over many years. A systematic review and meta-analysis study published with authors from the Department of Neurosurgery at Penn State Hershey Medical Centre yielded over 250 articles on the relationship between spinal manipulation and CAD.

While the meta-analysis revealed a small association between chiropractic care and dissection, the quality of the literature was very low and its relationship may be explained by the high risk of bias and confounding in the studies. They found there to be no convincing evidence to support a causal link between chiropractic manipulation and CAD. The association for a chiropractic visit resulting in a stroke was not greater than for a visit to another primary care physician such as a GP or specialist.

The confounders and complicating factors may be explained by the presentation of the patient with headache and neck pain that is associated with an artery dissection already in progress. Listen to the podcast as we discuss the importance of a good medical history and examination to determine the patient at risk of such an event.