While rare, serious adverse events, such as stroke, have been reported following chiropractic neck adjustments. The overall risk remains very low for individuals receiving cervical manipulation. Understanding these possibilities helps patients make informed decisions about their healthcare.
Understanding Neck Adjustments
A chiropractic neck adjustment, also known as cervical manipulation, involves a hands-on therapeutic technique to address issues with joint mobility, alignment, and function. During this procedure, a chiropractor applies controlled, precise pressure to specific joints in the neck. The goal is to restore normal joint movement and alleviate discomfort.
The “cracking” or “popping” sound often heard during an adjustment is a natural phenomenon called joint cavitation. It occurs when a rapid change in pressure within the joint’s synovial fluid causes dissolved gases, like nitrogen and carbon dioxide, to form and then quickly collapse into tiny bubbles. This sound does not indicate that bones are cracking or rubbing together; it simply signifies a release of pressure within the joint.
Extremely Rare Adverse Events
The rare adverse event associated with neck adjustments is vertebral artery dissection (VAD), which can lead to a stroke. This occurs when a tear develops in the inner lining of the vertebral artery, one of four major arteries supplying blood to the brain. Blood can then enter the arterial wall and form a clot, which may break off and travel to the brain, causing a stroke, or the expanding artery wall can narrow the vessel and impede blood flow.
Symptoms of VAD can emerge immediately after an adjustment or develop hours to weeks later. Estimates suggest these complications are very rare, ranging from approximately 1 in 100,000 to 1 in 5 million cervical manipulations. Some individuals may already have a vertebral artery dissection in progress, presenting with neck pain or headaches, making the association coincidental rather than causal. Underlying risk factors for arterial dissection include connective tissue disorders, hypertension, and smoking, although many cases occur spontaneously without apparent predispositions.
Recognizing Warning Signs
Patients should be aware of specific neurological symptoms that, though rare, could indicate a serious issue like a stroke or vertebral artery dissection following a neck adjustment. Sudden onset of a severe headache, often described as a “thunderclap” headache unlike any previously experienced, warrants immediate attention.
Other concerning signs include sudden, severe, or persistent dizziness or vertigo, nausea, and vomiting. Visual disturbances such as double vision, slurred speech, or difficulty swallowing are indicators. Sudden weakness, numbness, or clumsiness affecting one side of the body, particularly an arm or leg, also requires immediate emergency medical attention.
Minimizing Risk and Choosing a Chiropractor
Patients can take steps to minimize risk and make informed decisions about chiropractic care. Provide a comprehensive medical history to the chiropractor, including pre-existing conditions such as recent trauma, blood clotting disorders, or previous stroke or transient ischemic attack (TIA). Conditions like severe osteoporosis, tumors in the cervical spine, or certain connective tissue disorders may be contraindications for neck adjustments.
Inquire about the chiropractor’s qualifications, experience, and approach to cervical manipulation. Chiropractors are trained to conduct detailed assessments, including medical history reviews and physical examinations, to identify any underlying conditions or risk factors before performing adjustments. Open communication and asking questions about the treatment plan empower patients in their healthcare journey.