existing … Excuse me, the lack of recognition of a preexisting dissection or due to the CMT. This is a huge acknowledgment because one of the things that has been talked about in the literature extensively. I have testified too in court on a number of occasions and have counseled chiropractors and have been part of the lectures I have given on those subjects for over a decade is that the current thinking is that the majority of these cases are dissections in progress. They present core care through a chiropractor, through a medical doctor, through a physical therapist, to anybody, and that there are circumstances when the mature [outing 00:09:36] end up where it ends up, regardless of whether they saw the chiropractor, the medical doctor or went for a Starbucks that day. This is another huge point for us as practitioners. This does acknowledge that the situation that we are looking at maybe a preexisting condition. While I've heard a lot of chiropractors say, "Well, I don't need to worry about this problem because I practice NUCCA," which is extremely low force, or "I don't have to worry about this because I practice activator," or "I don't have to worry about this because I don't use any rotation in my cervical adjustments." If we read this sentence carefully and understand it, it's saying to us, "Be very careful, this isn't about what happens in your office. It's about what walks through the door of your office and the attention needs to be shifted now more toward the recognition of the preexisting dissection in progress rather than the thinking that this is caused in the chiropractor's office." Now, we can't rule that latter component out. The research is not strong enough one way or the other to say, we can say chiropractor care is not associated in any way with this, but what we can do is accept what this says. This is due to a lack of recognition of preexisting cervical dissection in these patients. There is a significant portion of these patients. They are in the process of dissection when they present for care and they go on to have this equality of the dissection and the stroke regardless of where they had gone that day. The conclusions of the American Heart Association, American Stroke Association, "Although current biomechanical evidence is insufficient to establish the claim that CMT causes CD, clinical report suggest that mechanical forces play a role in a considerable number of dissections and most population control studies have found an association between CMT and VAD in young patients."
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