In a deeply concerning incident, 29-year-old Joanna Kowalczyk from Gateshead, England, lost her life after seeking chiropractic treatment for neck pain stemming from a gym-related injury. This case has ignited discussions about the safety protocols in chiropractic care, especially concerning the necessity of thorough patient medical history evaluations prior to treatment.
The Initial Injury and Medical Consultation
In September 2021, Ms. Kowalczyk experienced a significant neck injury during a gym session, characterized by an audible “crack.” Concerned about the sudden pain, she visited a local hospital where a CT scan was performed. Medical professionals recommended a lumbar puncture to rule out the possibility of a hemorrhage. However, Ms. Kowalczyk, opting for alternative treatment methods, discharged herself against medical advice and decided to pursue chiropractic care for pain relief.
Over the course of four weeks, Ms. Kowalczyk underwent multiple chiropractic sessions. Notably, she informed her chiropractor about her recent hospital visit and the CT scan results. Despite this disclosure, the chiropractor did not request or review her medical records before initiating treatment. During an appointment on October 16, 2021, Ms. Kowalczyk suddenly experienced severe dizziness, double vision, tingling in her right hand and foot, and difficulty speaking—symptoms indicative of a potential stroke.
The chiropractor advised her to seek immediate medical attention. However, she did not go to the hospital right away. Later that day, paramedics were called to her home. After being informed that dizziness and migraines could be common after chiropractic adjustments, they diagnosed her with a migraine. Unfortunately, her condition deteriorated rapidly, and she was eventually taken to Queen Elizabeth Hospital in Gateshead, where she died three days later on October 19, 2021.
Underlying Health Conditions and Inquest Findings
An inquest into Ms. Kowalczyk’s death revealed that she had an undiagnosed connective tissue disorder, which made her more susceptible to arterial dissections—rare but potentially fatal tears in an artery’s lining. She also had a history of migraines and joint hypermobility issues. Assistant Coroner Leila Benyounes concluded that Ms. Kowalczyk’s death was caused by “a combination of the consequences of chiropractic treatment following a naturally occurring medical event.”
The coroner expressed concern that the chiropractor had not considered obtaining Ms. Kowalczyk’s medical records before treatment, despite being aware of her recent hospital visit and medical investigations. She noted that even an updated consent form from the British Chiropractic Association lacked a prompt for chiropractors to request medical records before assessment.
In light of this tragic incident, the coroner recommended that the General Chiropractic Council introduce guidelines requiring chiropractors to review a patient’s medical history before treatment. This recommendation underscores the importance of thorough patient assessments to identify any underlying conditions that could increase the risk of complications from chiropractic manipulations.
Understanding the Risks Associated with Chiropractic Neck Adjustments
Chiropractic neck manipulations, particularly high-velocity adjustments, have been associated with a risk of vertebral artery dissection—a tear in the inner lining of the vertebral artery, which can lead to stroke. While such complications are considered rare, they can have devastating consequences. A study published in the Proceedings (Baylor University. Medical Center) highlighted that an estimated 1 in 20,000 spinal manipulations results in a vertebral artery dissection and ischemic infarct. The risk is higher in individuals with connective tissue disorders, such as Marfan syndrome or Ehlers-Danlos syndrome, which make arteries more prone to dissection.
This case highlights the critical importance of thorough patient screening and history-taking in chiropractic practice. Chiropractors should be vigilant in identifying patients who may have underlying conditions that could predispose them to adverse outcomes from spinal manipulations. This includes: Before initiating treatment, chiropractors should obtain and review relevant medical records, especially if the patient has had recent medical investigations or treatments. Patients with a history of connective tissue disorders, migraines, or joint hypermobility may be at increased risk for arterial dissections. Recognizing these risk factors is essential for safe practice. Patients should be fully informed about the potential risks associated with chiropractic treatments, particularly neck manipulations, and alternative treatment options should be discussed.
The Role of Regulatory Bodies
Regulatory bodies, such as the General Chiropractic Council, play a crucial role in ensuring patient safety through the development and enforcement of practice guidelines. The coroner’s recommendation to mandate the review of patient medical histories before treatment is a significant step toward preventing similar tragedies in the future. It is imperative that these organizations implement and monitor compliance with such guidelines to uphold the standards of care in the chiropractic profession.
The untimely death of Ms. Joanna Kowalczyk serves as a poignant reminder of the potential risks associated with chiropractic neck manipulations, especially in individuals with underlying health conditions. This case underscores the necessity for thorough patient assessments, including the review of medical histories, to identify risk factors that may contraindicate certain chiropractic treatments. By implementing stringent screening protocols and adhering to evidence-based practice guidelines, the chiropractic profession can enhance patient safety and prevent such tragic outcomes in the future.
