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WFC Talking Points on AHA Scientific Statement on CMT and Cervical Artery Dissection

August 2014

A Scientific Statement titled Cervical Artery Dissections and Association with Cervical Manipulative Therapy for neurologists and other health professionals, written by Biller, Sacco et al. on behalf of the American Heart Association Stroke Council, was published online in the AHA’s journal Stroke on August 7 and may be found here.  There are a number of concerns with the statement, including the overall concern that it focuses on cervical manipulative therapy (CMT) when this is only one of many trivial movements/activities that have been associated with cervical artery dissection (CD).  

It has already been misinterpreted by some in the media and may be referred to in your country in the weeks and months ahead.  The WFC therefore provides these talking points.  It is recommended that any comment should be left to appropriately qualified spokespersons in the profession, who should focus on the positive aspects of the Statement which include:

1.    This statement is about cervical manipulative therapy (CMT) not chiropractic treatment.  Although it mentions accurately that spinal manipulations are most commonly performed in North America by chiropractors it notes “however they are also done by members of the allopathic, osteopathic and physical therapy/physiotherapy professions.” (Page 2, col 2, para 3.)

2.    There is no suggestion that CMT is inappropriate.  (On current research evidence it is a first line option for many patients on the grounds of safety, effectiveness and patient preference/satisfaction - for example those with common forms of neck pain and headache1).

3.    It is acknowledged that there is no clear evidence that cervical artery injury and stroke are caused by CMT, as opposed to being associated in time with it. (14/2/Conclusion.)  On this the AHA explains:

a.    Study of the forces reaching the cervical arteries during manipulation/CMT shows that these are insufficient to strain the arteries and are less than “during passive range of motion” (5/2/3).  In other words less than during normal medical examination procedures.

b.    The only study comparing the frequency of stroke after visiting either a chiropractor or a primary care medical doctor, reports no difference.  In the AHA’s words:  “Because patients with VAD (vertebral artery dissection) commonly present with neck pain, it is possible that they seek therapy for this symptom from providers, including CMT practitioners, and that the VAD occurs spontaneously, implying that the association between CMT and VAD/vertebrobasilar artery stroke is not causal.” (5/1/3.)

4.    It is acknowledged that the association between stroke and CMT is rare.  It is fair to say that the AHA statement does not make this sufficiently clear.  On this:

a.    The authors, in the conclusion say that “the incidence of CD (cervical artery dissection) in CMT patients is probably low” (14/2/Conclusion).

b.    In fact it is generally described by researchers as extremely low or rare with an incidence of about 1 in one million treatments2.  This can be better understood by most people if described as one incident in a group of 25 CMT practitioners all of whom have been in practice for 40 years.

c.    This form of ischaemic stroke is found following many apparently mild activities, such as turning to back the car, overhead painting, sports activities, yoga, prayer, etc.  Again, it is very rare.  No-one knows whether it is more common after CMT or any of the activities mentioned.

d.    CMT/neck manipulation is far safer than other common medical treatments for neck pain.  By comparison nonsteroidal anti-inflammatory drugs (NSAIDS) cause 153 stroke deaths per one million people3 and spinal surgery of the neck causes 500 stroke deaths per one million people4.

5.    The AHA’s conclusion is that health care professionals performing CMT should be aware of the possible association between CMT and CD, in rare patients with both severe neck pain or headache and with other factors associated with stroke that can be discovered from the patient history and exam.  There should be informed consent where appropriate.  The chiropractic profession has done much of the research in this field, is aware of the issues, and agrees.

1.    Haldeman S, Carroll LJ, Cassidy JD et al. (2008) A Best Evidence Synthesis on Neck Pain: Findings From the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.  Spine 33(4S):S1-S220.
2.    Haldeman S, Kohlbeck FJ, McGregor M (2001) Unpredictability of Cerebrovascular Ischemia Associated with Cervical Spine Manipulation Therapy: A Review of Sixty-Four Cases After Cervical Spine Manipulation.  Spine 27(1):49-55.
3.    (2005) Lanas A et al. A Nationwide Study of Mortality Associated with Hospital Admission due to Severe Gastrointestinal Events and Those Associated with Nonsteroidal Anti-inflammatory Drug Use. Am J Gastroenterology 100(8):1685-93.
4.    (2014) Marquez-Lara A, Nandyala SV et al.  Sentinel Events in Cervical Spine Surgery.  Spine Jan 29 [Epub ahead of print], http://www.ncbi.nlm.nih.gov/pubmed/24480955.


WFC Announces Next Secretary-General

June 11, 2014

Richard Brown 2013b small 
The World Federation of Chiropractic (WFC) is pleased to announce the appointment of Dr Richard Brown of Stroud, Gloucestershire in the United Kingdom as its next Secretary-General from July 1, 2015.  He will succeed Mr David Chapman-Smith, who retires from this position at that time, but will remain in a transitional role for one year until June 2016.

Dr Brown, who will be moving to Toronto, Canada to take up the position, is a 1990 graduate of the Anglo-European College of Chiropractic (AECC) who also holds a Master of Laws degree from Cardiff University.  From 2009-2013 he served as President of the British Chiropractic Association (BCA) and he currently holds the office of Secretary-General of the European Chiropractors’ Union (ECU).  He has broad academic experience as a lecturer at AECC and the University of Glamorgan, as a member of the AECC Board of Governors from 2006-2011 and as Secretary-General of the European Academy of Chiropractic.
Dr Brown has been in private chiropractic practice for 24 years, since 1999 as owner and Clinic Director of a large multidisciplinary practice in Stroud.  He served as a chiropractor in the medical team in the Polyclinic in the Athletes’ Village at the London 2012 Olympic Games.  He has extensive experience as an expert witness in regulatory fitness to practise hearings and clinical negligence litigation, drawing upon his combined qualifications in law and chiropractic.
In recent years Dr Brown, increasingly recognized as one of the profession’s foremost young leaders, has become well-known to the profession internationally as an invited lecturer in many countries and world regions.

“We are most excited to have someone of Dr Brown’s outstanding abilities, character and proven leadership experience to carry the WFC forward during the next decade,” says WFC President Dr Greg Stewart of Canada. “Although the search process produced five highly talented final candidates at interview, his selection was unanimous by both the Search Committee and the WFC Council.”

Current WFC Secretary-General David Chapman-Smith added his endorsement.  “In Richard I see a person with exactly the qualities the WFC now needs and that I hoped my successor would have.  He is a man of many talents, a true spirit of service, strong communication skills and a profound understanding of the international profession and the direction it and the WFC should take for future success.”

Dr Brown is married with two adult daughters.  He is a keen soccer fan and combines his enthusiasm with providing chiropractic services to two professional teams in the English Football League.  He enjoys writing and is a keen motorcyclist.  In preparation for his move to Canada he has just sold his practice, and he plans to provide volunteer chiropractic services to an underserved community through World Spine Care during the first half of 2015.

Dr Greg Stewart Elected WFC President

June 10, 2014

 Greg Stewart web
The World Federation of Chiropractic (WFC) is pleased to announce that Dr Gregory B Stewart of Winnipeg, Manitoba, Canada was elected President for a 2-year term at the WFC Executive Council Meeting held last month in San Juan, Puerto Rico. He succeeds Dr Dennis Richards of Australia, now Past President.
Dr Stewart, who received a Bachelor of Physical Education from the University of Manitoba (1982), graduated as a Doctor of Chiropractic (cum laude) from the Canadian Memorial Chiropractic College in Toronto in 1986. He has been in fulltime private practice in Winnipeg, Manitoba since that time, and has served on many provincial and national chiropractic committees since 1990. These include committees on the identity of the profession, government relations, ethics, communications, interprofessional collaboration, chiropractic legislation, third party and government service negotiations, clinical practice guidelines and research.

Dr Stewart has served as President of the Manitoba Chiropractors’ Association (1994 – 1997) and the Canadian Chiropractic Association (CCA, 2002 – 2003), and has represented Canada and the North American Region on the Council of the World Federation of Chiropractic since 2006, most recently as First Vice-President. In 2012 he received the CCA’s highest honor, the Medal of Merit, for outstanding services to the profession.

“I am excited by the advances and new opportunities for the chiropractic profession in many countries at present, and the vision and quality of the leaders beside me on the WFC Council”, says Dr Stewart. “For these and other reasons the work of the WFC is more important than ever, and I see significant new progress in research, education and practice over the next two years if we continue to maintain high standards and work together.”

Other officers elected in Puerto Rico were Dr Espen Johannessen, Norway, First Vice-President, Dr Carlos Ayres, Peru, Second Vice-President, and Dr Rick McMichael, USA, Secretary-Treasurer.


ACF Publishes First Newsletter

October 2013

Cover -ACF-Newsletter-1 web  

The African Chiropractic Federation (ACF), representing national associations of chiropractors in Africa and newly formed at the WFC Congress in Durban last April, has now published its first newsletter, which may be read here.

Items include biographies of African chiropractors in several countries, news stories, and notice of the first Annual Meeting and Seminar to be held in Nairobi, Kenya from April 3-5, 2014.  Keynote speakers are Drs Francis Murphy and Brian McAulay, generously sponsored by Parker University.

Congratulations to ACF News editors Drs Praveena Maharaj, South Africa, and Neera Sharma Maini of Kenya.


Chiropractic Under the African Sun

May 2013

CASA President Simon Lawson

CASA President Dr. Simon Lawson opens the Congress

From April 8–13 the Chiropractic Association of South Africa (CASA) hosted the World Federation of Chiropractic’s 12th Biennial Congress, titled Chiropractic Under the African Sun, at the International Convention Center in Durban, South Africa.

More than 750 delegates from 42 countries attended the Congress, the largest and most impressive meeting ever held in Africa.  Many rated it “the best ever” chiropractic event in their lives.

“This was a wonderful Congress in very, very many respects”, said Dr Bill Meeker, President, West Campus Palmer College, which was one of the major sponsors together with Neuromechanical Innovations and Foot Levelers.
Photo by Auerbach
Photo courtesy of Dr. Gary Auerbach

Beyond outstanding academic and social programs there were many special celebrations and events since this was the Silver Anniversary of the WFC which was formed 25 years ago in 1988.  These included:
•    A video from researchers worldwide honoring Dr Scott Haldeman who was retiring as Chair of the WFC Research Council after 25 years of distinguished leadership.

•    Renaming of the original research awards as the NCMIC Louis Sportelli Research Awards to honor both Dr Sportelli for his career of leadership in building research capacity for the profession, and the NCMIC Group Inc. for its long term funding of the main awards.  From the 174 research submissions received, first and second prizes of US$12,000 and US$7,500 respectively were awarded for research papers from research teams affiliated with the Canadian Memorial Chiropractic College (CMCC) and led by Dr Jessica Wong and Dr Jairus Quesnele.

•    Launch of an illustrated history titled The Global Advance of Chiropractic: The World Federation of Chiropractic 1988-2013 authored by Dr Reed Phillips.  This history documents the international expansion of the chiropractic profession during the past generation, is of exceptional quality, contains over 600 images. To purchase, please fax or email this order form.

•    Honor Awards for outstanding service towards the international growth of the chiropractic profession to Mr. Kent Greenawalt, CEO, Foot Levelers, USA, Dr Jean Moss, President, CMCC, Canada, and Dr Anthony Metcalfe of the UK, a Past-President of the British Chiropractic Association, the European Chiropractors’ Union (ECU) and the WFC.

Jessica Wong

Dr Jessica Wong of Toronto, Canada receives
the Scott Haldeman Award First Prize in the original research competition from (left) Dr Haldeman, Dr Louis Sportelli, Dr Greg Kawchuk and Dr Claire Johnson.
  Anniv Cake
Dr Dennis Richards, WFC President, Dr Gary Auerbach, first WFC President 1989-92, and David Chapman-Smith, Secretary-General, cut the silver anniversary birthday cake at the Saturday Gala Banquet.

One important goal of holding this WFC Congress in Africa was formation of a regional organization to represent and advance the chiropractic profession in Africa, the only world region without such a regional organization.  That was achieved with the formation of the African Chiropractic Federation (ACF) at the WFC Assembly by chiropractic delegates from 13 nations – Botswana, Congo, Ethiopia, Ghana, Kenya, Liberia, Mauritius, Mozambique, Namibia, Nigeria, South Africa, Uganda and Zimbabwe.

The first ACF seminar meeting is to be held in Nairobi, Kenya from April 3-5, 2014, hosted by the Chiropractic Association of Kenya.

“Our Silver Anniversary Congress was such a success because of many partners and individuals,” said WFC President Dr Dennis Richards of Australia, “but none more so that the members of the CASA Local Planning Committee led by Dr Caileen Walker and Dr Reg Engelbrecht.  The WFC and everyone who attended this historic meeting are greatly indebted to them.”

Special thanks are also due to many exhibitors and sponsors, led by Platinum Sponsor Neuromechanical Innovations (Dr Christopher Colloca, President).  Many of these donated prizes to a fundraising raffle which raised over $5,000 to support the inspirational work of Sister Brigitte Yengo DC, MD at her orphanage at Brazzaville in the Congo (www.SisterYengo’sChildren.org).

The next WFC Congress is to be held in Athens, Greece from May 14-16, 2015, together with the annual convention of the ECU and hosted by the Hellenic Chiropractic Association.  WFC member associations in the Asia and Pacific Regions are being invited to bid to host the 2017 Congress.

 African Fed
Sister Yengo DC, MD and other African national delegates at the Banquet.

Status of the Chiropractic Profession

January 2013

At the request of the World Health Organization the World Federation of Chiropractic has this month filed a summary report on the status of chiropractic with WHO.  For text see – the report.

For much other information go to About Chiropractic and About WFC at this website.


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