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Neck Cracking Raises Stroke Risk

Should Chiropractors Warn of Real but Small Danger?



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.


"At the end of last week I was having neck pain," Haldeman says. "I know very well there is a risk of complication, but I didn't want to go through the weekend with my neck hurting. So on Saturday, I had an adjustment on my neck."


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