Cervical manipulation is a technique used by chiropractors, osteopaths, physical therapists and others to treat neck pain and headaches. There is an ongoing debate about whether neck manipulation is better than other forms of treatment for neck pain or headache, and about whether neck manipulation is in fact dangerous. The most recent “British Medical Journal” – BMJ – has fanned the flame by debating whether cervical neck manipulation should be completely abandoned.
This is an important discussion because there is a risk of stroke associated with cervical manipulation, specifically the rapid thrust used to rotate the cervical spine in order to realign cervical vertebrae. Your vertebral arteries are vulnerable to tearing during this kind of manipulation because of their location, around the top cervical vertebra – the atlas. Any abrupt rotation, such as that in a chiropractic or osteopathic neck manipulation, can stretch and tear the artery. The torn artery can become blocked depriving the brain of oxygen, or form a clot which can break loose and enter the brain. Either way, it can cause a stroke.
The incidence of stroke due to injuries suffered during cervical manipulation is low: the medical journal “Neurologist” reports that the best estimate is that about 1.3 persons out of every 100,000 chiropractic patients who receive a neck adjustment suffer a stroke following the treatment.
While this number is not high, there is still a risk, and the consequences of stroke are heartbreaking and devastating. Since there are other treatments that are more conservative and yet still effective – such as the use of heat, ice, gentle stretching and over-the-counter pain medicine – you might decide that forceful cervical manipulation isn't worth the risk.
Although many chiropractors use screening tests to rule out patients who may be susceptible to arterial damage, the medical journal “Spine” says that stroke after cervical manipulation is so unpredictable that screening tests are unreliable. Researchers who authored this article in “Spine” studied as many known cases as possible to try to identify any pattern that could predict who is most at risk for stroke from a neck manipulation, but were unable to do so.
If you do have a cervical manipulation and feel faint, dizzy or nauseated afterward, report it to your chiropractor right away. If there is a possibility of damage to an artery, immediate treatment is necessary.
Spine: Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation.