Chiropractic care uses spinal adjustments to restore movement, reduce pain, and improve physical function. Many individuals seek these non-invasive options for musculoskeletal conditions. Public interest in the safety of neck manipulations is high.
Understanding Cervical Adjustments
A cervical adjustment, or neck manipulation, involves a chiropractor applying a controlled, sudden force to specific neck joints. This HVLA thrust aims to improve spinal motion, reduce nerve irritation, and restore alignment. A popping sound, called cavitation, may occur from gas bubbles releasing within the joint’s synovial fluid. The goal is to enhance joint movement and physical function.
Potential Injuries Associated with Neck Manipulation
While generally safe, neck manipulation has been associated with rare but serious injuries. One is vertebral artery dissection, a tear in an artery supplying blood to the brain. This tear can lead to a blood clot, potentially causing an ischemic stroke. The hypothesized mechanism involves neck extension and rotation during high-velocity manipulation, which can strain these arteries.
Nerve damage is another infrequent complication. This can manifest as cervical radiculopathy, where a neck nerve root is compressed or irritated, leading to pain, numbness, or weakness radiating into the arm. More severely, cervical myelopathy involves spinal cord compression, resulting in symptoms like hand clumsiness, gait instability, or bladder function changes. These deficits may worsen if manipulation is performed on an already compromised spine.
Disc injuries, like a herniated disc, are rare occurrences following neck manipulation. A herniated disc happens when a spinal disc’s soft inner material pushes through its outer layer, potentially pressing on nearby nerves. While chiropractic care treats existing disc issues, forceful manipulation can theoretically cause or worsen a disc herniation.
Statistical Likelihood of Serious Complications
Serious complications following neck manipulation are uncommon. Estimates for the risk of serious adverse events, such as stroke, range from 0.05 to 1.46 per 10,000,000 manipulations. Other reports suggest an incidence of vertebral artery dissection (VAD) after cervical manipulation between 1 in 1.3 million and 1 in 400,000 manipulations.
Establishing a direct cause-and-effect relationship between neck manipulation and stroke is challenging, as symptoms like neck pain and headache often precede both chiropractic visits and spontaneous VAD. Some studies indicate no excess risk of VAD stroke for those visiting a chiropractor compared to those seeking care from a primary care physician for neck pain. A study of Medicare beneficiaries aged 66-99 found similar stroke proportions at 7 days for both chiropractic and primary care cohorts.
Patient and Practitioner Factors for Safety
Patient safety during neck adjustments depends on both the patient and practitioner. Patients must provide a complete medical history to tailor treatment and identify contraindications. Disclosing pre-existing conditions like vascular issues, osteoporosis, recent trauma, or inflammatory diseases helps the chiropractor assess risks. Without this, adjustments might not be suitable for the patient’s health.
Practitioners contribute to safety through thorough patient assessment and appropriate technique. Before any neck adjustment, a chiropractor typically conducts a detailed evaluation, including medical history review, physical examination, and sometimes neurological tests. Diagnostic imaging, such as X-rays, may be recommended to understand neck structure or rule out serious conditions. Obtaining informed consent and clear communication about findings and treatment options are integral to safe, patient-centered care.
Recognizing and Responding to Symptoms
Following a neck adjustment, recognize and respond to any new or worsening symptoms. Mild soreness, stiffness, or a temporary headache are common and typically resolve within 24 to 48 hours. However, certain symptoms warrant immediate medical attention. “Red flag” symptoms include severe or sudden thunderclap headaches, prolonged dizziness, vision changes, slurred speech, or difficulty swallowing.
Other concerning neurological symptoms requiring prompt evaluation are new or worsening weakness, numbness, or tingling in the limbs, or issues with balance and coordination (ataxia). If any of these symptoms occur immediately or shortly after a neck adjustment, seek emergency medical services. For milder, persistent concerns not resolving within a couple of days, discuss them with the chiropractor or primary care physician.