Navigating the New Reality: Post-COVID Risk Management for Chiropractors

Originally published: 2025-05-01

The COVID-19 pandemic may feel like a chapter that's closing for much of the world — but for chiropractors, the public health emergency is far from over.
In her groundbreaking lecture, Dr. Kate Dreher pulls back the curtain on the ongoing, unseen risks that demand a complete rethinking of chiropractic clinical protocols. Patient physiology has changed dramatically. The expectations of safe, routine care must now be re-examined.

“You can no longer assume a healthy-looking patient is a safe patient.”

The Spike Protein’s Lasting Legacy: Why It Changes Everything

Understanding the Mechanism Behind the Risk

The SARS-CoV-2 spike protein is not just a transient invader — it is a persistent disruptor of the body's vascular and immune systems. Dr. Dreher explains how the spike protein binds aggressively to ACE2 receptors, destabilizing the renin-angiotensin system and leading to widespread endothelial dysfunction, clot formation, and chronic inflammation.

“It’s not just about the infection. It’s about what the spike protein leaves behind.”

This disruption underpins a rising tide of cardiovascular, neurological, and oncologic conditions, many of which may not show obvious symptoms until significant damage is done. Even asymptomatic individuals may harbor vascular or immune changes that increase their risk of catastrophic events.

The New Clinical Baseline: Assume Risk, Always

Rethinking How We Evaluate and Manage Every Patient

In the post-COVID world, no patient — regardless of age, appearance, or health history — can be treated as low-risk by default. Chiropractors must update their patient intake, review of systems, and daily evaluations to include probing for subtle signs of vascular, clotting, or immune dysfunction.

Dr. Dreher emphasizes the importance of:

• Performing bilateral blood pressure checks

• Taking detailed COVID-19 and vaccination histories

• Conducting neurovascular assessments routinely, not just for new patients

• Using differential diagnosis mnemonics (VINDICATE / VITAMIN C D) to think beyond musculoskeletal causes

“Patient safety requires clinical vigilance, not clinical assumptions.”

Emerging Red Flags: What to Watch For

Symptoms That May Signal Deeper Trouble

Seemingly minor symptoms now demand closer scrutiny. Chiropractors must be alert to:

• New onset or persistent headaches

• Neck stiffness or pain without clear injury

• Dizziness, vertigo, or balance disturbances

• Visual changes or transient weakness

• Chest tightness or unexplained shortness of breath

These could be the early whispers of vascular dysfunction, clotting disorders, or neurological compromise — all of which require immediate recognition and possible referral.

Risk Mitigation Strategies: Protect Your Patients and Your Practice

Building Layers of Safety into Clinical Practice

In addition to updating clinical evaluations, Dr. Dreher advises chiropractors to:

• Thoroughly document all findings and patient histories

• Modify adjusting techniques when indicated (use low-force or instrument-assisted methods for high-risk patients)

• Pause care when red flags are detected and refer appropriately

• Maintain open channels of communication with local medical providers

Proper documentation is no longer a bureaucratic burden — it is a frontline defense in protecting your license and demonstrating your adherence to an evolving standard of care.

The Ethical Imperative: Raising the Bar on Professional Conduct

Leading Through the Crisis with Integrity

Dr. Dreher reminds chiropractors that ethics — a code of values guiding daily decisions — is now more important than ever. Chiropractors must balance their desire to provide care with the hard reality that some patients may be too high-risk for manual adjusting without further medical clearance.

“Practicing above the bar ethically is no longer optional. It’s mandatory for survival.”

Conclusion: A Call to Clinical Courage and Adaptation

The world has changed. The patients walking through chiropractic office doors are not the same as they were in 2019. Neither can chiropractic practice be the same.

The choice is stark: evolve clinical procedures to meet this new reality, or risk devastating consequences for patients — and for the future of chiropractic itself.

Dr. Dreher's message is clear: Stay vigilant, stay informed, stay ethical. Your patients' lives — and your professional life — depend on it.