A recent tweet about a woman who developed stroke symptoms after a chiropractor cracked her neck has drawn attention to a relatively rare but real cause of stroke in some people: chiropractic neck manipulation.
The tweet went viral with 33,000 likes and 3 million views.
Medical literature has documented several such cases, and there have been a few widely reported cases in the media. Earlier this year, a woman in New Mexico said she had a stroke after a chiropractor cracked her neck in an attempt to alleviate stiffness; in 2016, a 34-year-old model died from a stroke after a neck adjustment.
“It is a known risk factor for stroke,” said Dr. Joe Whittington, a California-based emergency medicine physician with Kaiser Permanente who has posted about this on TikTok. Whittington said he had personally seen three cases.
In fact, any sudden movement of the cervical spine — which includes the seven bones in the neck — can cause this type of injury to the neck arteries.
That includes auto accidents, cracking your own neck, and even though it’s rare, coughing very hard, said Dr. Raymond Bertino, senior author of an article on the relationship between chiropractic treatment and having a stroke.
Adjustments, or when the chiropractor applies pressure or performs a sharp movement on joints in an effort to reduce pain and restore function, are a key component of chiropractic treatments.
How common are these strokes?
The woman whose case was reported on Twitter wrote, “The reason [the hospital] got me in so fast is strokes happen from neck cracking all the time.”
“All the time” is an overstatement. Estimates of the actual incidence vary dramatically, said Dr. Andrew Rogove, medical director of stroke service at South Shore University Hospital in Bay Shore, New York.
Some have posited that it’s 1 in 100,000 and others say 1 in 1 million, although the truth is probably somewhere in between, said Dr. Steven Levine, vice chair of neurology and distinguished professor at SUNY Downstate in New York.
The study coauthored by Bertino found that 12 of 141 patients with cervical arterial dissection (a tear in one of the arteries in the neck) at one institution had recently undergone chiropractic neck adjustments. Cervical artery dissections in general are relatively rare, occurring in about 3 in 100,000 people each year, according to Harvard Medical School.
How the strokes happen
Most people have four blood vessels (the cervical arteries) that supply blood to the brain through the neck — two carotid arteries and two vertebral arteries, Bertino said.
Strokes that are caused by some kind of neck manipulation typically (though not always) involve the vertebral arteries, called a vertebral artery dissection. These two arteries are located in the back of the neck and supply blood to the back parts of the brain, namely the brain stem and the cerebellum, Bertino said.
Blood vessels in this area often are fragile and prone to tearing. When a vessel tears, blood clots form to stop the bleeding, which can lead to a stroke, said Dr. Mohammad Hirzallah, assistant professor of neurology and neurosurgery at Baylor College of Medicine. Hirzallah has personally seen only three patients with this serious condition in his 10 years of practice.
Stroke in younger people
Whether or not they result from chiropractic treatment, cervical artery dissections are the most common cause of stroke in people younger than 50.
That said, strokes are still relatively rare in people under 45. About 10% to 15% of the 795,000 strokes that happen each year in the US are in adults 18 to 45, or about 80,000 people.
Younger people may have different recovery outcomes than older people. “As we get older, our brains atrophy so there’s more room to swell after stroke,” Hirzallah said. “Younger patients don’t have as much room to swell, so there may be more complications.”
Can a chiropractor aggravate an existing problem?
The common early symptoms of an artery dissection are headache and neck pain before the condition progresses to neurological symptoms like weakness, slurred speech, and clumsiness, Levine said.
Of course, this is the very reason many people seek help from a chiropractor, which raises the question of whether neck manipulation is making an existing problem worse.
"Some reports have associated high-velocity upper neck manipulation with a certain rare kind of stroke, or vertebral artery dissection. However, evidence suggests that this type of arterial injury often takes place spontaneously in patients who have pre-existing arterial disease," according to the American Chiropractic Association. "These dissections have been associated with everyday activities such as turning the head while driving, swimming, or having a shampoo in a hair salon."
What to know about getting treatment at the chiropractor
The ACA says that cervical manipulation, or a neck adjustment, can help relieve muscle spasms, pressure, and tension in the neck. "Neck manipulation, when performed by a skilled and well-educated professional such as a doctor of chiropractic, is a remarkably safe procedure," they said.
While many people find chiropractors to be helpful for a variety of ailments, Bertino cautions against seeing one for neck trouble.
“It doesn’t bother me for somebody to see a chiropractor for low back pain if they’re having trouble getting relief from typical medical work,” he said. “But I would never recommend anyone go to a chiropractor for anything in the neck. It’s too risky.”
Is it really a bad idea to crack your own neck?
Chances are, you won’t be able to muster up enough strength to give yourself a stroke if you crack your own neck.
“I’ve heard of it probably about six or seven times,” Whittington said. “I think the force is much greater when somebody else is doing it.”
Similarly, while Whittington has heard about artery dissections during a roller coaster ride, that, too, is less likely just because the force is less.
How to recognize a stroke
If you have symptoms of a stroke, call 911 right away. It’s a medical emergency and doctors say ‘time equals brain,’ meaning the faster you get treatment for a stroke, the less likely you are to have permanent brain damage.
“You don’t wait a little bit to see if the symptoms go away. You don’t go in a car,” Rogove said.
The best way to remember the symptoms of a stroke is with the acronym BE FAST, he said:
- Balance: being off balance
- Eyes: double vision, loss of vision on one side of the visual field
- Face: facial droop, particularly on one side, or an uneven smile
- Arms: one arm is weak or droops when you try to lift it
- Speech: slurred speech, other problems in trying to express yourself verbally
- Time: time to call 9-1-1
“Many people get some pain relief from chiropractic treatment. I tell friends to get chiropractic treatment only from the neck down,” Hirzallah said. “Don’t let anyone touch your neck.”