Crack the neck. Crack the back. Manipulations that can have serious consequences, if we are to believe doctors who warn of the risks associated with certain osteopathic or chiropractic practices.
The death in 2016 of Katie May, American media model nicknamed the “Queen of Snapchat”, following a stroke whose origin was established by the medical examiner as being “the manipulation of the neck by a chiropractor”, is undoubtedly the most emblematic and extreme case. Still, doctors are trying to alert on social networks, like Doc Amine, a Marseille practitioner followed by 110,000 people on Instagram and nearly 50,000 on Twitter. In an early August post spotted by BFM-TVthe latter reports the case of a patient sent “to the emergency room for a suspicion of cerebellar stroke, a little earlier his osteopath would have cracked his neck”, he wrote.
Other serious cases are reported in the scientific literature, such as that reported by general practitioner Marc Gozlan in his blog from World, devoted to current events in medicine and biology. It tells the story of a young woman who remained severely disabled following a stroke that occurred three weeks after a spinal manipulation session with a chiropractor. A manipulation established as the cause, according to doctors from the CHU de Reims. So many frightening and isolated stories that can be brandished to discredit the professions of osteopaths and chiropractors, regulated since 2007. Here and thereother doctors report fractures resulting from poor handling.
“Like anyone who cares, it can sometimes go wrong”
“It’s quite unhealthy,” despairs Philippe Sperlingot, president of the French union of osteopaths. “We have been witnessing for a year, a year and a half the rise of osteobashing, in particular on the part of the collective NoFakemed (group of doctors wishing to “alert on the dangers of fake medicines”). I’m not saying that nothing ever happens, and like anyone who cares, it can sometimes go wrong. But to date, no work has demonstrated correlations between cervical manipulation and stroke, ”says the osteopath based in Nantes. For him, this risk of stroke post-manipulation, “is a bit in the realm of belief. At the moment the big question for doctors is to ask if their patient has seen an osteo recently and as 25% of French people consult it at least once a year…”, he illustrates froma study carried out in 2019. “We can all have a patient who comes to us with an ongoing stroke,” he continues. Stroke is a process that can take several weeks for a blood clot to form and travel to the brain.
Therefore, according to the osteopath, the challenge lies more in training in order to detect people who either have a clot in the process of forming (and which can be the source of the pain leading them to the osteopath) or in who these manipulations would be contraindicated due to the fragility of their bone walls. Osteopaths are trained in five years in recognized schools, but “not sufficiently controlled by the State. Among the thirty schools in France, there are a dozen that do not work well, ”says Philippe Sperlingot.
“Back problems are not solved with manipulation, but with physical activity”
Beyond the manipulations which would lead to extreme consequences such as strokes for which it is “difficult” to directly incriminate osteopaths or chiropractors, believes Nicolas Pinsault, physiotherapist and researcher at the University of Grenoble, specialist in care pathways. But for him, even if the cases “are extremely rare”, manipulations of the vertebrae and cervical can well cause “arterial dissections”, that is to say, a tear in an artery with eruption of blood between two layers of the vascular wall. Also, Nicolas Pinsault ensures that colleagues working in back clinics regularly operate on patients with disc binding induced by improper handling or the repetition of it.
“The problem is that, unlike the United States, French osteopaths and chiropractors are not recognized as health professionals and they do not have an x-ray to observe any lesions before/after manipulations”, he advances. With one osteopath for just over 3,000 inhabitants, France is the country in the world with the largest number of these practitioners. And according to the researcher, the explanation is to be found in the inadequacy of conventional medicine in certain treatments. “Nine million French people suffer from the back, and the reality is that we are not good at this problem, so patients turn to osteopaths or chiropractors. When you have a bacterial infection, you don’t think about alternative medicine, ”he explains. “Back problems are not solved with manipulations, but essentially with physical activity”, continues the physiotherapist.
Few studies
At the French association of chiropractors, we “take the problem very seriously”, assures Charlène Chéron, its spokesperson. “There is an apprehension among doctors vis-à-vis unconventional approaches and with osteopaths, we are often put in the same basket as etiopaths and naturopaths who are unregulated professions”, she regrets. A British study of Chiropractic & Manual Therapies published in 2017, “suggests that there is no causal relationship between spinal manipulation and stroke”, and concludes “it seems possible that pre-existing pathologies could increase the risk of occurrence of these events. Consequently, the challenge lies in the detection of these risk factors”.
However, the scientific literature on this subject remains scarce and these phenomena, ultimately, little studied. Which seems logical, given the relative newness of these professions, which have been structured since the beginning of the century.