The Ring Dinger carries real risks, including the potential for arterial dissection, disc herniation, and ligament injury, though the exact frequency of serious harm from this specific technique has not been studied in a clinical trial. The maneuver, a form of high-velocity manual cervical traction popularized on social media by Houston chiropractor Gregory Johnson, applies a sudden pulling force along the length of the neck while the patient lies face-up on a table. It often produces a dramatic cascade of cracking sounds that play well on camera but tell you almost nothing about what is happening inside the joint. The absence of peer-reviewed research on the Ring Dinger itself does not mean the risks are hypothetical; the biomechanical forces it generates overlap with forces known to damage cervical arteries, ligaments, and discs.
What the Ring Dinger Actually Does to Your Neck
During the maneuver, the practitioner cups the patient’s chin and occiput (the base of the skull), then applies a sharp axial traction force, essentially yanking the head away from the torso. The goal, according to its proponents, is to decompress the cervical spine and restore alignment. What makes the Ring Dinger distinctive compared to conventional chiropractic cervical adjustments is the speed, the magnitude of the pull, and the full-spine distraction that sometimes accompanies it. Standard cervical adjustments tend to target a single spinal segment with a short-lever thrust; the Ring Dinger loads the entire cervical column at once.
Biomechanical research on cervical traction tells us something important here. A finite element analysis of spinal traction found that axial traction forces can reduce intradiscal pressures by generating tensile stress across the annulus fibrosus, the tough outer ring of each disc.1PubMed Central. Traction therapy in lumbar disc hernias: A finite element analysis study That sounds beneficial, and in controlled therapeutic settings it can be. But the key word is “controlled.” Clinical traction devices apply measured, steady forces over minutes. The Ring Dinger applies a sudden, manual jerk in a fraction of a second, and the practitioner has no instrument telling them how many newtons they are generating.
The audible cracking, which viewers often interpret as a sign the technique “worked,” is actually cavitation: the rapid formation and collapse of gas bubbles in the joint fluid when joint surfaces are suddenly separated. Research on joint manipulation sounds has shown that this cavitation occurs during a sudden joint distraction that happens faster than the stretch reflexes of the surrounding muscles can respond.2PubMed Central. The audible release associated with joint manipulation In plain language, the pop happens so fast that the muscles meant to protect the joint cannot brace in time. That is why it sounds dramatic, and it is also why the forces involved bypass some of the body’s built-in protective mechanisms.
The Vascular Risk That Worries Neurologists Most
The single most alarming risk associated with forceful cervical manipulation is vertebral artery dissection, a tear in the inner wall of the arteries that run through channels in the cervical vertebrae and supply blood to the brainstem and posterior brain. This is not a theoretical concern. Case reports in the medical literature document strokes following chiropractic neck manipulation, and the mechanism is well understood anatomically.
The vertebral arteries are particularly vulnerable at the V3 segment, where they loop around the top two vertebrae before entering the skull. A case report of bilateral vertebral artery dissection and acute stroke following chiropractic manipulation noted that the V3 segment is highly susceptible to bending forces during forced manipulation, leading to intimal damage, meaning a tear of the artery’s inner lining.3Stroke: Vascular and Interventional Neurology. Abstract 1122‐000200: Chiropractor Manipulation Leading to Bilateral Vertebral Artery Dissection and Acute Ischemic Stroke Once the lining tears, blood can pool inside the arterial wall, narrow the vessel, and trigger clot formation that travels to the brain.
Another published case described vertebral artery dissection after chiropractic neck manipulation, concluding that the vertebral arteries are at risk for aneurysm formation or dissection, either of which can cause acute stroke.4PubMed Central. Vertebral artery dissection after a chiropractor neck manipulation The internal carotid arteries face a similar threat. Research on extracranial artery dissections has found that sudden severe stretch, compression, or prolonged extension, flexion, or rotation of the neck can cause dissections by stretching the internal carotid artery over the transverse processes of the upper cervical vertebrae or the vertebral artery over the lateral masses of C1 and C2.5Annals of Vascular Surgery – Brief Reports and Innovations. Investigation of extracranial internal carotid and vertebral artery dissection after cervical spine manipulation
The Ring Dinger combines axial traction with some degree of extension and sometimes rotation as the practitioner positions the patient’s head. That combination is precisely the kind of loading pattern these case reports implicate. The fact that the maneuver is applied quickly and forcefully only compounds the concern, because the arteries have no opportunity to accommodate the stretch gradually.
Ligament and Disc Injuries
Your upper cervical spine is held together by small but critical ligaments, and these have measurable failure thresholds. The alar ligaments, which connect the top of the second cervical vertebra (the dens) to the skull, had an in vitro failure strength of about 200 newtons in one classic biomechanical study, while the transverse ligament, which holds the dens against the front arch of the first cervical vertebra, failed at around 350 newtons.6PubMed. Biomechanics of the craniocervical region: the alar and transverse ligaments That same study noted that the alar ligament, because of its lower strength and the direction it is loaded, might be prone to injury more often than is normally assumed.
A more recent study using a larger set of cadaver specimens found a higher mean failure force for the alar ligament, around 394 newtons, though the range was wide (roughly 317 to 503 newtons).7PubMed Central. Update on the Biomechanics of the Craniocervical Junction, Part II: Alar Ligament The discrepancy between the two studies underscores an important point: ligament strength varies considerably from person to person, depending on age, connective tissue quality, and prior injury. A force that is well within the safety margin for a healthy 25-year-old might be at or near the failure threshold for an older patient or someone with a connective tissue disorder.
Disc injuries are another documented consequence of forceful spinal manipulation. A case report described a patient who developed cervical intradural disc herniations at two levels (C4-C5 and C5-C6) after excessive spinal manipulation therapy, causing severe spinal cord compression and progressive quadriparesis, meaning the patient was losing function in all four limbs.8PubMed Central. Cervical Intradural Disc Herniation Causing Progressive Quadriparesis After Spinal Manipulation Therapy: A Case Report and Literature Review That is an extreme and rare outcome, but it illustrates that the forces involved in aggressive cervical manipulation can overwhelm the structural capacity of the disc, especially if a disc is already degenerated or bulging.
Research on cervical spine ligament behavior under fast loading rates, the kind of rapid deformation that occurs during a high-velocity maneuver, has characterized the failure properties of cervical soft tissues under these conditions.9PubMed. Failure properties of cervical spinal ligaments under fast strain rate deformations The takeaway is that speed matters: soft tissues behave differently when loaded fast versus slow, and fast loading can cause failure at forces that might be tolerated under gradual application.
Who Faces the Greatest Risk
Certain groups of people are far more vulnerable to harm from forceful cervical manipulation, and anyone considering the Ring Dinger should know whether they fall into one of these categories.
- Older adults: Age-related degeneration narrows the spinal canal, thins ligaments, and stiffens arteries, all of which lower the threshold at which a forceful traction maneuver can cause damage. Cervical spondylosis, a near-universal finding in people over 60, means the spine has less room to accommodate sudden distraction.
- People with connective tissue disorders: Conditions like Ehlers-Danlos syndrome make ligaments, blood vessel walls, and other soft tissues more fragile. A report on chiropractic management of Ehlers-Danlos patients concluded that low-force adjusting techniques should be preferred in people with tissue fragility, offering a way to minimize risks compared to traditional spinal manipulation.10PubMed. Chiropractic management of Ehlers-Danlos syndrome: a report of two cases The Ring Dinger is the opposite of low-force.
- People with existing disc problems: If you already have a bulging or herniated disc in the cervical spine, rapid traction can push the herniation further, potentially compressing the spinal cord.
- Children and adolescents: Pediatric cervical spines are structurally different from adult ones. Biomechanical testing of pediatric cervical specimens found that younger children’s spines failed at significantly lower forces than older children’s, with average failure occurring at roughly 595 newtons for two-to-four-year-olds versus 868 newtons for six-to-twelve-year-olds.11PubMed. Biomechanical assessment of the pediatric cervical spine under bending and tensile loading High-velocity cervical traction is not appropriate for growing spines.
- People on blood thinners: Anticoagulant medications increase the severity of any vascular injury, turning a minor arterial tear that might self-seal into a major dissection or hemorrhage.
Many of these risk factors are not things a patient would think to mention, and not all practitioners screen for them thoroughly before performing the maneuver. The social media context in which the Ring Dinger is marketed does not exactly encourage cautious patient selection.
How Common Are Side Effects from Spinal Manipulation Generally
Even setting aside rare catastrophic events, spinal manipulation is not free of side effects. A systematic review of adverse effects from spinal manipulation found that relatively mild adverse effects occur in roughly 30% to 61% of all patients, based on prospective reports.12PubMed Central. Adverse effects of spinal manipulation: a systematic review These include things like local soreness, stiffness, headache, and fatigue in the hours following treatment. Most resolve within a day or two, but they are common enough that patients should expect them.
A practice-based survey of chiropractic patients found that side effects were reported after about 30% of visits, with muscle soreness accounting for roughly a third of all side effects reported. The vast majority, over 99%, were classified as mild. Only six moderate side effects (sprains or strains) were documented out of more than 3,000 visits, and no severe side effects were reported in that sample.13PubMed Central. Patient-reported side effects immediately after chiropractic scoliosis treatment: a cross-sectional survey utilizing a practice-based research network That data comes from conventional chiropractic care, not specifically the Ring Dinger, but it establishes a useful baseline. Standard adjustments already produce transient discomfort in a significant fraction of patients. A more forceful technique applied to the entire cervical spine would be expected to at least match and likely exceed those rates.
What the Evidence Says About Cervical Traction
Defenders of the Ring Dinger sometimes argue that traction is a well-established treatment for neck problems, and therefore the Ring Dinger is just an updated version of something evidence-based. That argument has a significant gap in it. A systematic review of mechanical traction for neck disorders found only low-quality trial evidence, with some benefit seen for intermittent traction in reducing pain. Continuous traction showed no significant difference for defined outcomes.14PubMed. Mechanical traction for mechanical neck disorders: a systematic review
The traction studied in clinical trials is a very different animal from what happens in a Ring Dinger session. Clinical cervical traction uses a harness and a calibrated weight or motorized device to apply a known, steady force, typically between 5 and 15 kilograms, over a span of minutes. The patient’s muscles have time to relax and accommodate, and the force is ramped up and down gradually. The Ring Dinger replaces all of that with a single, abrupt, manually applied pull at a speed and force that cannot be precisely measured or replicated. Citing the traction literature in defense of the Ring Dinger is a bit like citing the safety record of elevators to defend bungee jumping: the basic physics overlap, but the application is completely different.
The Social Media Problem
The Ring Dinger would be an obscure technique practiced in a single clinic if not for YouTube and TikTok. Videos of the maneuver have accumulated millions of views, and the dramatic cracking sounds generate the kind of visceral reaction that social media algorithms reward. Viewers see a patient walk in with neck pain and walk out cracking a grin. What they do not see is a screening process, an informed consent discussion, or follow-up when things go wrong.
This creates a specific danger beyond the biomechanical risks already discussed. Patients arrive at chiropractors’ offices requesting the Ring Dinger by name, having self-diagnosed their problem as one that needs “decompression.” They may not disclose relevant medical history because the viral videos did not suggest it mattered. And some practitioners, seeing the marketing value of the technique, may perform it on patients who should not receive it, because turning away a paying client who specifically asked for a trending service requires a commitment to patient safety that not every practitioner shares.
The informed consent question is also worth thinking about. The duty of disclosure in healthcare has evolved over decades from a practitioner-centered standard (the doctor decides what to share) to a patient-centered one, where patients are entitled to know material risks that would affect their decision.15BioMed Central / Chiropractic & Manual Therapies. Informed consent, duty of disclosure and chiropractic: where are we? A patient considering the Ring Dinger is entitled to hear that vertebral artery dissection, disc herniation, and ligament injury are possible outcomes, however rare. Whether that conversation is actually happening in practices that promote the technique on social media is an open question.
Why You Cannot Just Rely on the Practitioner’s Experience
A common reassurance offered by Ring Dinger practitioners is that they have performed the technique thousands of times without incident. This sounds convincing but has a statistical problem. Vertebral artery dissection from cervical manipulation is estimated to be rare in absolute terms, on the order of a handful of cases per million manipulations in broader chiropractic data. An individual practitioner could perform the technique for years without seeing a catastrophic outcome simply because the event rate is low. That does not mean the risk is zero; it means the sample size of any single practitioner’s experience is too small to detect a rare event.
There is also a survivorship bias at work. The patients who appear in Ring Dinger videos are, by definition, the ones who did well enough to be filmed and consent to posting. Patients who experienced worsening symptoms, delayed-onset headaches, or vascular injury do not typically end up in promotional content. And because there is no registry or mandatory reporting system for adverse events from chiropractic manipulation in most jurisdictions, the true complication rate from this specific technique is unknown and likely to remain unknown.
What to Do If You Are Considering It
If you are experiencing chronic neck pain and are attracted to the idea of cervical decompression, there are lower-risk approaches that have at least some evidence behind them. Controlled mechanical traction administered by a physical therapist, with measured forces and gradual application, addresses the same theoretical goal with far less risk. Manual therapy techniques that target individual spinal segments with low-velocity mobilization are another option. Exercise-based rehabilitation programs for the cervical spine have a stronger evidence base than any manual technique and carry essentially no risk of vascular injury.
If you still want to pursue high-velocity cervical manipulation of any kind, at minimum you should get screened for vascular risk factors and preexisting cervical pathology beforehand. A practitioner who is unwilling to take a thorough history, perform a neurological exam, or discuss the possibility of arterial dissection before applying force to your neck is not someone whose hands you want near your cervical spine. Ask directly whether they screen for connective tissue disorders, use of blood thinners, and history of stroke or vascular disease. If the answer is vague, walk out.
Neck Cracking Videos and the Misunderstanding of Pain Relief
A final piece worth understanding is why the Ring Dinger feels good to many patients who receive it, despite the risks. The audible crack and the sudden joint distraction likely trigger a short-term neurophysiological response: a burst of input from joint mechanoreceptors that temporarily overrides pain signaling, combined with the psychological satisfaction of hearing and feeling something “release.” Research has noted that the cavitation event during manipulation happens so fast that it precedes the stretch reflexes of nearby muscles, and some researchers have proposed that this rapid stimulation of high-threshold periarticular receptors may initiate reflex actions that account for some of the perceived benefits.2PubMed Central. The audible release associated with joint manipulation
That short-term relief is real, but it does not mean anything structural has been corrected. Discs do not “go back into place” from a single pull, and vertebrae that were not displaced do not need to be realigned. The temporary feel-good effect can create a cycle in which patients return repeatedly for the sensation, each visit re-exposing the cervical arteries and ligaments to forces that, while individually unlikely to cause harm, accumulate over time. For a technique with no published evidence of long-term benefit and well-documented mechanisms of potential harm, that trade-off deserves more scrutiny than a viral video can provide.