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Neck Cracking Raises Stroke Risk

Should Chiropractors Warn of Real but Small Danger?


"If a person has any of the symptoms of stroke, he or she should bypass the chiropractor and go directly to the hospital," Smith says.

These red flags are:

  • One side of the body becomes weak, numb, or paralyzed.
  • Double vision, blurry vision, or loss of sight.
  • Trouble speaking or difficulty understanding speech.
  • Loss of balance or coordination; dizziness.
  • Sudden severe headache.

"Neck cracking," or cervical spinal manipulation, is the chiropractic technique that most concerns neurologists. To make this adjustment, the practitioner often gives the neck a high velocity twist. Chiropractors are trained to know the anatomy of the neck. Other kinds of practitioners, Smith says, may not be so well aware of the risks. He notes that many chiropractors already are adopting a less forceful technique for cracking necks.

Scott Haldeman, DC, PhD, MD, is a chiropractor as well as a neurologist. As clinical professor of neurology at the University of California, Irvine, he's studied many cases of arterial dissection in chiropractic patients.

Haldeman says the Smith study has a major weakness: It relies on patients' memories of events years in the past. Also, he notes that even though the study took place in California -- where people do more spinal manipulations than anywhere else -- only seven cases of stroke could be linked in any way to neck cracking.

"I think the basic information in the Smith study is very important. It does confirm that there is a temporal relationship between stroke and spinal manipulation that we cannot rule out," Haldeman tells WebMD. "But their evidence that spinal manipulation is a major cause of stroke is weak. The risk is not zero, and none of us is suggesting there isn't some risk. What we have basically got here is a situation we have to put into perspective."

If you have neck pain, Haldeman asks, what are you supposed to do? Taking aspirin or ibuprofen puts you at small but real risk of getting an ulcer. No other medication is proven to work. Surgery is unproven and has its own risks. However, Haldeman says, there is evidence that exercise and spinal manipulation can ease neck pain in the short term.

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