Teaching setting significantly influenced how chiropractic faculty members conceptualize and communicate CeAD risk, with classroom faculty more frequently characterizing the cSMT-CeAD relationship as associational while clinical faculty more frequently endorsed a causal relationship mediated by modifiable risk factors.
Key Findings
Results
Teaching setting was significantly associated with faculty perspectives on whether cervical spinal manipulative therapy causes cervical artery dissection.
Pearson's chi-square or Fisher's exact test yielded p = 0.013 for the association between teaching setting and CeAD causation beliefs.
Classroom faculty more frequently characterized the cSMT-CeAD relationship as associational (73% vs. 27%).
Clinical faculty more frequently endorsed a causal relationship mediated by modifiable risk factors (63% vs. 33%).
85 faculty members met inclusion criteria out of 103 responses, comprising 46 classroom and 38 clinical faculty (1 undisclosed).
Results
A majority of chiropractic faculty reported that perceived CeAD risk influenced their instructional approach.
72% of respondents reported that CeAD risk influenced their instructional approach.
The primary instructional modifications were pretreatment screening and technique modification.
Qualitative analysis of free-text responses identified four themes related to how faculty discuss CeAD in teaching contexts.
Free-text responses were provided by 19 of the 85 included respondents.
Four themes were identified: Clinical Assessment & Management (89.5% of responses), Risk & Safety (52.6%), Education & Training (31.6%), and Evidence Base (21.1%).
Analysis used keyword extraction and keyword-based thematic analysis.
Clinical Assessment & Management was by far the most prevalent theme, appearing in nearly 9 out of 10 free-text responses.
Methods
Individual faculty members from 17 of 28 invited chiropractic programs participated, representing a 61% program-level response rate.
The survey was distributed via Qualtrics to institutional gatekeepers from 28 English-speaking chiropractic programs between February and March 2025.
Gatekeepers distributed the survey to instructors with hands-on experience teaching cervical manipulation within the prior five years.
103 total responses were received, with 85 meeting inclusion criteria.
The gatekeeper-led sampling approach limits individual-level response rate calculation and generalizability.
Discussion
The study identified opportunities to strengthen evidence-aligned patient safety education and establish instructional guidance across chiropractic programs.
No standardized instructional guidance across chiropractic programs regarding CeAD risk communication was identified.
Findings reveal inconsistencies in how CeAD risk is conceptualized and communicated depending on teaching setting.
The authors note that the debate regarding the cSMT-CeAD association has been longstanding and that biomechanical and epidemiologic studies have examined this relationship.
Little was previously known about how chiropractic educational programs address CeAD or how individual faculty perceptions shape instructional practices.
What This Means
This research suggests that chiropractic educators hold notably different views about the relationship between neck manipulation and a rare type of stroke-related injury called cervical artery dissection (CeAD), and that these differences are linked to where they teach. Faculty who teach in classrooms were more likely to view the connection between neck manipulation and CeAD as merely an association — meaning the two things occur together but one doesn't necessarily cause the other — while faculty who supervise students in clinical settings were more likely to believe that manipulation can directly cause CeAD under certain modifiable conditions. Despite these differing views, most faculty (72%) said that their concerns about CeAD risk did affect how they teach, primarily by incorporating pre-treatment screening and modifying techniques they demonstrate or supervise.
The study surveyed faculty from 17 of 28 chiropractic programs across English-speaking countries, collecting 85 usable responses. When faculty were asked to elaborate in free text, their comments most commonly addressed clinical assessment and management of CeAD risk, followed by safety considerations, educational and training issues, and the underlying evidence base. This suggests that while faculty are engaged with the topic of patient safety, there is no consistent, standardized approach to teaching about CeAD across chiropractic programs.
This research suggests that the chiropractic profession lacks unified educational guidelines on how to communicate CeAD risk to students, and that a practitioner's teaching environment may shape their understanding of a clinically important safety issue. The authors note this creates an opportunity for chiropractic programs to develop more consistent, evidence-based curricula on CeAD risk, which could ultimately improve patient safety practices. The study's reliance on a gatekeeper distribution model means the true individual response rate cannot be calculated, and findings may not be fully generalizable to all chiropractic programs worldwide.
Lambert C, Ross K, Major C, Burnham K, Hatch S, Anderson B. (2026). Educational approaches to the relationship between cervical adjusting and risk of cervical artery dissection; a survey of chiropractic faculty.. Chiropractic & manual therapies. https://doi.org/10.1186/s12998-026-00675-7