Is chiropractic treatment safe in Singapore?

Previously I have written about cases where people died after one or more chiropractic adjustments. There was Joanna Kowalczyk who passed away after several chiropractic treatments in 2021. The cause of her death was stroke through tears in her vertebral artery. The coroner reported that the initial tears were likely sustained during personal training but worsen with cervical chiropractic adjustments.

The more high profile case was Katie May. She was a former Playboy model who passed away after seeing chiropractic care for neck pain. The coroner reported stated that it was likely the result of a neck manipulation by the chiropractor.

With severe side effects, the most important question for Singaporeans seeking chiropractic care is if chiropractic is safe.

No reported deaths from chiropractic treatment in Singapore

To the best of my knowledge, there is no death from chiropractic treatments from Singapore to date. There are no formal statistics to if anyone suffered a stroke from seeking chiropractic  treatment in Singapore.

The closest report of death after seeking care from a chiropractor is from Indonesia. It was big news when it happened in 2015. The Indonesian government closed the big chain, Chiropractic First, in Indonesia. The company was the same as the Chiropractic First operating in Singapore then but the chiropractor was American Randall Cafferty.

Prior to moving to Asia, Randall Cafferty had his chiropractic licence revoked from the California Board of Chiropractic Examiners. Matt Kan Wai Ming, the founder of Chiropractic First, was also wanted by the Indonesian authorities for potentially being negligent for hiring Randall Cafferty.

Randall Cafferty still remains wanted by the Indonesian government and appears to reside in India. Based on news report from India earlier this year, Delhi Court rejects Indonesia’s extradition request for the chiropractor.

Lack of regulation for chiropractors in Singapore

The lack of regulation for chiropractors in Singapore is confusing for consumers. Just a few months ago, Singapore Medical Council had clarified that chiropractors are not registered medical doctors. I honestly think regulation will allow the Singapore government to better control the narrative of chiropractic care in Singapore. This means being able to clearly define who is and is not a chiropractor, and also being able to set the scoop of practice for chiropractors.

Without regulation, the authorities are also unlikely to be able to take any action against chiropractors should something go awry.

While the government is not explicitly supportive of chiropractors, there is also no objective to chiropractic businesses operating in Singapore. In 2011, the then Minister of Health, Khaw Boon Wan, stated in parliament that chiropractors would retain their right to practise even if they are not considered an allied health provider.

Chiropractors are legally allowed to practise and operate in Singapore. However, they are neither medical practitioners nor allied health workers.

What are the risks of chiropractic neck adjustment?

The most extreme risk of a chiropractic manipulation is death. It is extremely rare, rare enough for us to not have a reported case in Singapore, but it is still a risk.

It is serious and should be taken seriously. However, that doesn’t mean chiropractic adjustments is inherently harmful. The first chiropractic clinic in Singapore opened in 1978. It’s been almost half a century and the safety record looks promising for now. Millions of chiropractic adjustments are probably performed in Singapore each year!

Other less severe strain and quite often reported would include muscle strain or joint sprain. Most of these will resolve on their own within days to about two weeks. Post-adjustment soreness is also often reported, especially among first timers. The soreness tend to last for a couple of days and will go away on its own.

Are all neck manipulations created equal?

The short answer is no. I must say that I am adamant that nobody should receive a y strap adjustment (aka the ring dinger). Anatomically speaking, it does not make sense. It does not appear to be healthy for the cervical facet joints (i.e., small joints in your neck), and the potential for injury to the vertebral artery is also very high.

Worse, there is no absolute way to screen who will respond well to these adjustments. With the potential risks and limited benefit in view, it is my opinion that they should be avoided altogether.

HVLA, high velocity low amplitude, chiropractic techniques are likely the best for the cervical spine. In HVLA maneuvers, the speed of the chiropractic thrust is fast but the actual movement is very minimal. This does allow for a satisfy cavitation (i.e., popping sound) with minimal risk of injury to the previous blood vessels in your neck.

Some flexion and limited rotation of the spine is best

For those with anatomical knowledge, it is good to seek out chiropractors who can adjust the neck in flexion with minimal rotation. The easiest way is to see how a chiropractor sets a patient’s neck before they apply the thrust. If the neck is extremely crooked and lean back, there is a lot of rotation and extension.

What you want to see is a chiropractor who gently cradles the head, and place the head with some but not excessive rotation prior to the thrust. Some chiropractors would lift up the headrest and not cradle the neck for ergonomics purpose. This is also acceptable as the cervical spine would still be in slightly flexed position.

There is no absolute way to eliminate all adverse risks of a chiropractic adjustment. If in doubt, just avoid it altogether. Furthermore, the symptoms of neck pain and stroke can be very difficult to differentiate at the earlier stages. In the case of Joanna Kowalczyk, she was assessed for stroke by both chiropractors and paramedics but was screened negative. However, there was almost certainly already tearing in her vertebral arteries.

Everything come with risks, treatments or otherwise

Last weekend, a 47-year-old Certis auxiliary police officer died after collapsing during a National Day Parade (NDP) rehearsal at the Padang. I don’t believe the cause of death is known yet.

Earlier this year, a 23-year old runner died after running 19km at the 2XU Compression Run. The Indonesian man Leonard Darmawan collapsed and initially appeared to be fine. His condition, however, later worsened and he passed away later that morning. Cardiorespiratory failure was the cause of death indicated on his death certificate.

There were also two freak accidents where powerlifters broke their neck during a squat. The first was Indonesian Justyn Vicky, bodybuilder and influence. The second was Yashtika Acharya, an Indian national powerlifter, who lost her footing during a squat. Both were fit individuals but unexpected passed away from squatting.

Medical treatments also come with risks

In May 2020, a woman was admitted to Mount Elizabeth Novena for labour to be induced. As part of the delivery procedure, an incision was made by obstetrician Dr Khoo Chong Kiat to aid the birth. The lady subsequently suffered a tear which lead to faecal matter being excreted from her vagina.

The patient sued the doctor but the court did not find Dr Khoo Chong Kiat to be negligent. The incision was considered to be routine for vaginal birth and no consent was deemed to be required.

Facts of the case aside, standard and even quality medical care does come with risks. Of course the outcome for the lady is not the best but there are possible adverse outcomes with every treatments.

Even simple injections have side effects

Many years ago, orthopaedic surgeon Dr Lim Lian Arn was unjustly fined $100, 000 for not obtaining consent for a simple procedure. The treatment was a steroid injection!

The fine was so ridiculously high that the Ministry of Health stepped in to ask the Singapore Medical Council to apply for the court for a review. Upon review, the fine was reduced to no more than $20,000.

This unfortunate case started when a patient filed a complaint against Dr Lim Lian Arn for failing to advise on the side effects of a steroid injection on her wrist. The side effects she experienced were swelling and pain for two hours, as well as discolouration, loss of muscle and fat tissue.

Are chiropractic neck adjustments safe for you?

There is no treatments that I know of that comes with zero risks. Even if the treatment is inert (i.e., dummy treatment), it still has the potential to cause an nocebo effect.

The common side effects to having your neck adjusted are fairly mild. Post-manipulated soreness tend to last for a few hours to a couple of days, and tend to resolve on their own. The more serious but common side effects would be muscular strain or joint sprains. Most of these also tend to self-resolve though the more severe ones may need additional treatment.

Stroke is a real but extremely rare complication associated with chiropractic adjustments to the neck. Most of these cases are likely to already have suffered tears in their vertebral arteries prior to the neck manipulation. However, it is possible that adjustments can make the tears worse or delay patients from seeking treatment that could save their lives.

At Square One Active Recovery, we don’t offer spinal manipulation at all as its benefits are often very short-lived. With the risks associated with neck adjustments, the potential value is fair too limited to justify the risks. When in doubt, always choose to err on the side of caution.