t's a question some patients are understandably concerned about:
Can a chiropractic neck adjustment cause a stroke?
The concern primarily involves a rare condition called cervical artery dissection, in which a tear develops in the wall of an artery supplying blood to the brain.
Because cervical artery dissection can sometimes initially present as neck pain or headache—the same symptoms that might lead someone to visit a chiropractor—the relationship between neck manipulation and stroke is more complicated than it may initially appear.
Here's what patients should understand.
What Is a Cervical Artery Dissection?
Several important arteries travel through the neck and supply blood to the brain.
A cervical artery dissection occurs when a tear develops within the wall of one of these arteries. Blood can enter the artery wall and interfere with normal blood flow or contribute to formation of a blood clot.
In some cases, this can result in an ischemic stroke.
Cervical artery dissections are uncommon, but they're an important cause of stroke in younger and middle-aged adults.
Why Is Chiropractic Care Part of the Discussion?
Some strokes caused by cervical artery dissection have occurred after neck manipulation.
That has led researchers to investigate whether cervical manipulation itself can cause an arterial injury.
But there's an important complication:
Neck pain and headache can themselves be early symptoms of a cervical artery dissection.
That means someone who is already developing a dissection may seek treatment for what initially appears to be ordinary neck pain or a headache.
This makes determining cause and effect difficult.
What Does the Research Tell Us?
Research has found an association between healthcare visits for neck pain or headache and subsequent diagnosis of certain types of stroke.
However, an association doesn't necessarily prove that the treatment received during that visit caused the stroke.
One frequently cited study examining vertebrobasilar stroke found similar associations involving visits to chiropractors and primary-care physicians among younger patients. The authors suggested that people experiencing symptoms from an existing vertebral artery dissection may seek care for headache or neck pain before the stroke occurs.
That doesn't establish that cervical manipulation carries zero risk.
Rather, it demonstrates why accurately determining the risk is difficult.
Is the Risk Zero?
No medical treatment should be described as completely risk-free.
Serious complications following cervical manipulation appear to be rare, but cervical artery dissection and stroke are serious conditions.
Patients should be informed about potential risks, and chiropractors should evaluate patients for symptoms or history that could indicate that cervical manipulation isn't appropriate.
Warning Signs That Need Immediate Medical Attention
A sudden or unusual headache or neck pain—particularly when accompanied by neurological symptoms—shouldn't simply be assumed to be a routine musculoskeletal problem.
Seek emergency medical care for symptoms such as:
- Sudden weakness or numbness, particularly on one side
- Difficulty speaking or understanding speech
- Facial drooping
- Sudden difficulty walking
- Significant loss of balance or coordination
- Double vision or other sudden visual disturbances
- Sudden severe dizziness with other neurological symptoms
- A sudden, severe, or distinctly unusual headache
These symptoms warrant prompt medical evaluation rather than chiropractic treatment.
Not Every Patient Needs the Same Neck Treatment
Seeing a chiropractor for neck pain doesn't automatically mean you need a high-velocity neck adjustment.
Treatment should be based on your history, examination findings, symptoms, comfort, and individual risk factors.
Depending on the situation, chiropractic care may involve different manual techniques as well as mobility exercises, rehabilitation and movement, or other conservative approaches.
If your presentation raises concern for a vascular or neurological condition, the appropriate next step may be medical evaluation rather than treatment.
Why Your History and Examination Matter
Before treating neck pain, we want to understand more than simply where it hurts.
Important information can include:
- How and when the symptoms began
- Whether there was an injury
- Whether the pain is sudden or unusual
- Headache characteristics
- Neurological symptoms
- Medical history
- Current medications
- Cardiovascular and vascular history
- Examination findings
No screening process can eliminate every possible risk, but careful history-taking and clinical evaluation are important parts of determining whether chiropractic treatment is appropriate.
Making an Informed Decision About Chiropractic Care
Patients should feel comfortable asking questions about any healthcare treatment they're considering.
If you're concerned about cervical manipulation, tell your chiropractor.
You can ask:
Why are you recommending this treatment?
What are the potential benefits and risks?
Are there other treatment options?
What symptoms would make you choose not to adjust my neck?
Good healthcare should involve informed decisions rather than simply assuming the same treatment is appropriate for everyone.
Chiropractic Care for Neck Pain in Maple Grove, MN
At Northwood Chiropractic & Wellness, treatment recommendations are based on your history, examination findings, symptoms, and individual needs.
If chiropractic care is appropriate, we'll explain what we're recommending and why.
And if your presentation suggests that additional medical evaluation is needed, we'll help direct you toward the appropriate next step.
Our goal is to provide appropriate conservative musculoskeletal care while helping you understand your treatment options.
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Your first visit includes a consultation, comprehensive exam, X-rays if needed, and your first chiropractic adjustment when clinically appropriate.
Dr. Greg Beenken
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