Educational approaches to the relationship between cervical adjusting and risk of cervical artery dissection; a...

Cervical artery dissection (CeAD) remains a rare but clinically important condition that has generated longstanding debate regarding its potential association with cervical spinal manipulative therapy (cSMT). Although biomechanical and epidemiologic studies have examined this relationship, little is known about how chiropractic educational programs address CeAD or how individual faculty member's perceptions shape instructional practices. This study surveyed chiropractic faculty members who actively teach cervical manipulation to understand how educators conceptualize CeAD risk and incorporate safety considerations into curricula.

An anonymous twelve-item electronic survey was distributed via Qualtrics to institutional gatekeepers from 28 English-speaking chiropractic programs between February and March 2025. Gatekeepers then distributed the survey to instructors with hands-on experience teaching cervical manipulation within the prior five years. Survey items assessed teaching setting, beliefs about the cSMT-CeAD relationship, and whether perceived risk influenced screening procedures and technique modification. Quantitative data were analyzed using descriptive statistics, Pearson's chi-square tests, and Fisher's exact test; qualitative free-text responses underwent keyword extraction and keyword-based thematic analysis.

Individual faculty members from 17 of the 28 invited chiropractic programs participated (61% program response rate), yielding 103 responses with 85 meeting inclusion criteria (46 classroom, 38 clinical, 1 undisclosed). Teaching setting was significantly associated with faculty perspectives of CeAD causation (p = 0.013); classroom faculty more frequently characterized the cSMT - CeAD relationship as associational (73% vs. 27%), while clinical faculty more frequently endorsed a causal relationship mediated by modifiable risk factors (63% vs. 33%). Most respondents (72%) reported that CeAD risk influenced their instructional approach, primarily through pretreatment screening and technique modification. Qualitative analysis of free-text responses (n = 19) identified four themes: Clinical Assessment & Management (89.5% of responses), Risk & Safety (52.6%), Education & Training (31.6%), and Evidence Base (21.1%).

Teaching setting significantly influenced how chiropractic faculty members conceptualize and communicate CeAD risk. Findings reveal opportunities to strengthen evidence-aligned patient safety education and establish instructional guidance across chiropractic programs. The gatekeeper-led sampling approach limits individual level response rate calculation and generalizability.