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Chiropractic Research Review

Addressing Syncope and the Cervical Adjustment

Awareness of the potential side effects of manipulation is important when adjusting the cervical spine. Previous literature has identified vertebrobasilar accidents or strokes as the most devastating negative outcomes, with manipulation involving rotation hypothesized to be a potential source of danger.

Clinical experience has shown a range of patient responses to assessment and manipulation of the head and neck, including transient ischemic attack (TIA), vertigo and syncope.

Previous studies have addressed TIA and vertigo; however, syncope has not been adequately discussed as a distinct entity, or in terms of its potential relation to chiropractic intervention.

Syncope is defined as a temporary loss of consciousness not associated with epilepsy. Syncope often presents with neurocirculatory asthenia, vasomotor instability and vasovagal reactions. The following may cause syncope:

* decrease in cerebral circulation;
* transient decrease in cardiac output;
* decrease in arterial pressure to less than 50 mm Hg; or
* decrease in oxygen and/or glucose to the brain.

The authors of the current study discuss syncope as a clinical entity, and present a series of six cases in which syncope occurred during chiropractic visits involving manipulation of the cervical spine. All six cases occurred in a single private practice setting in Victoria, Australia. Intervention in all cases involved traditional care comprised of physical examination, directed orthopedic and neurologic testing, and manual spinal adjustment /soft tissue manipulation.

Conclusion: "It appears that transient syncope is an event likely to be observed by practitioners of therapeutic intervention to the cervical spine... One would reasonably expect ... further formal investigation of transient syncope and related clinical events high on the chiropractic research agenda."

Ebrall P, Ellis WB. Transient syncope in chiropractic practice: a case series. Chiropractic Journal of Australia, Sept. 2000:30(3), pp82-91.
Reprints: Tel: +61 2 6921 3238; Fax: +61 2 6926 2556; E-mail: chance@wagga.net.au

Chiropractic Research Review

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