Educational approaches to the relationship between cervical adjusting and risk of cervical artery dissection; a survey of chiropractic faculty

Abstract

Abstract Background 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 faculty perceptions shape instructional practices. This study surveyed chiropractic faculty who actively teach cervical manipulation to understand how educators conceptualize CeAD risk and incorporate safety considerations into curricula. Methods An anonymous twelve-item electronic survey was distributed via Qualtrics to faculty from 28 English‑speaking chiropractic programs between February and March 2025. Snowball sampling recruited instructors who had taught hands‑on 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 and chi‑square tests; qualitative responses underwent keyword extraction and topic modeling. Results Faculty from seventeen of the 28 invited chiropractic programs participated (61% program response rate), yielding 103 responses with 75 meeting inclusion criteria; 49 were classroom faculty and 26 were clinical faculty. Teaching setting significantly influenced faculty perspectives on CeAD causation (p = 0.03). Classroom faculty more likely to report that cSMT is rarely or never causally related to CeAD (67% vs 42%), whereas clinical instructors more frequently acknowledged a causal relationship mediated by modifiable risk factors (58% vs 33%). Most faculty (73%) incorporated CeAD education through didactic instruction and case-based discussions. Qualitative analysis of free text responses were organized into four major themes: (1) Clinical Assessment & Management; (2) Risk & Safety; (3) Education & Training; (4) Evidence Base. Conclusions Teaching setting significantly influenced how chiropractic faculty conceptualize and teach CeAD risk. Findings reveal opportunities to strengthen evidence‑aligned patient‑safety education and establish instructional guidance across chiropractic programs. The collection method used in this study makes calculating response rate difficult, limiting generalizability.