The fear that a chiropractor could accidentally fracture a patient’s neck is a common source of anxiety surrounding spinal care. Chiropractic care primarily involves manual therapy, including spinal manipulation, which applies a controlled, rapid force to a joint. This article provides an evidence-based context for this concern, exploring the actual level of risk. Data shows that severe adverse events are exceedingly rare, and the primary safety concern is often misunderstood.
Understanding the Actual Risk Level
The idea of a literal cervical fracture, or a “broken neck,” resulting from a standard chiropractic high-velocity adjustment is statistically negligible. The most serious risk, often conflated with a broken neck, is a severe adverse event (SAE): a stroke caused by Vertebral Artery Dissection (VAD). Data suggests the rate of a stroke following cervical manipulation is extremely low, estimated at one to two incidents per million manipulations performed.
Multiple large-scale population studies have concluded there is no evidence of excess VAD or stroke risk associated with a chiropractic visit compared to a primary care physician (PCP) visit. This suggests that patients who are already experiencing a dissection—often presenting with neck pain and headache—seek care from either practitioner before the stroke occurs. The association is considered coincidental rather than a causal link to the manipulation itself.
The Mechanism of Serious Injury
The rare serious complication involves the vertebral arteries, which travel through the neck vertebrae to supply blood to the brainstem and cerebellum. A VAD, or Vertebral Artery Dissection, is a tear in the inner lining of this artery. This tear allows blood to pool, potentially forming a clot or impeding blood flow, which can lead to an ischemic stroke.
The concern is that the high-velocity, rotational thrust used in some cervical manipulations could mechanically stress an artery, causing a tear. However, in many cases, the artery is already weakened or dissecting due to an underlying condition, such as a connective tissue disorder, or from minor trauma like a sudden sneeze. The manipulation may simply be the final stressor that occurs shortly before the pre-existing dissection causes symptoms, rather than the true cause of the initial tear. The mechanism is a vascular event, not a bony fracture.
Safety Protocols and Patient Screening
Chiropractors employ a thorough screening process to identify patients who may be at a higher risk for adverse events before performing any manipulation. The process begins with a comprehensive patient history to identify red flag symptoms, which include the sudden onset of severe or unusual headaches, dizziness, or visual disturbances. These symptoms can indicate an already developing arterial dissection and require an immediate medical referral rather than manipulation.
Practitioners also look for absolute contraindications that prohibit high-velocity adjustments, such as severe osteoporosis, acute fractures, or known cervical instability. A neurological examination is standard practice to assess reflexes, sensation, and strength, helping to rule out nervous system compromise. This risk mitigation strategy relies heavily on the clinician’s judgment and detailed intake to ensure the patient is appropriate for the proposed treatment.
Low-Force Techniques and Alternatives
Patients who remain concerned about the high-velocity thrust (HVT) associated with traditional manipulation have a wide variety of low-force alternatives available. These techniques are designed to achieve therapeutic goals without the rapid, rotational movement that creates the perceived risk of arterial stress. One common method is spinal mobilization, which uses gentle, rhythmic stretching and passive movements to restore joint function and increase the range of motion.
Other alternatives include instrument-assisted techniques, such as the Activator Method, which utilizes a small, handheld device to deliver a precise, low-force impulse to the joint. This method bypasses the twisting motion of a manual adjustment and is often preferred for patients who are sensitive or have conditions like osteoporosis. Patients can and should discuss their anxieties with their chiropractor to ensure a treatment plan is chosen that respects their comfort level while still providing effective care.