Neck Adjustments And Stroke: What You Need To Know Before Going To The Chiropractor

Chiropractic care is one of the most popular yet hotly contested forms of medicine out there. Countless people say the practice, which involves adjusting the spine and neck into various positions, has alleviated musculoskeletal issues that other, more traditional treatments couldn’t help. But many health care providers warn people to think twice before heading to a chiropractor for neck pain.

Last week, a tweet from an emergency medicine doctor highlighted how a specific element of chiropractic care — so-called rapid neck manipulation — may lead to “devastating strokes,” even in young people who don’t have any apparent cardiovascular risk factors. The post, shared by Dr. Emily Porter, garnered a ton of attention, leading hundreds of people to weigh in with their own experiences of how chiropractic treatment changed their life — for better or worse.

According to Dr. Charles R. Wira III, an internal and emergency medicine physician at Yale Medicine who specializes in stroke and emergency critical care, there’s a well-known link between chiropractic neck manipulations and cerebrovascular dissection, a tear in a major artery that can trigger a stroke.

“Thankfully, overall the incidence of neck dissections are small,” Wira told HuffPost. “But intentional and aggressive manipulations of the neck merits strong consideration for concern.”

The neck contains four of the most important arteries in the body — two carotid arteries and two vertebral arteries — that pump blood from the heart to the brain. These give the brain oxygen, nutrients and everything it needs to sustain life, according to Dr. Leah Croll, an assistant professor of clinical neurology at Temple University’s Lewis Katz School of Medicine and a neurologist at Temple University Hospital.

When the neck experiences a sudden, powerful movement — as it can during certain chiropractic adjustments — these arteries can get injured. “Having your neck manipulated, particularly when it’s being moved at high speeds or with a lot of force, can increase your risk of something called arterial dissection, which is a tear in the wall of one of your arteries,” Croll said. Arterial dissections present with a bad headache or neck pain, and they can lead to the formation of blood clots. These clots can travel to the brain, interrupt blood flow and cause a stroke.

Typically, such strokes occur one to four weeks after chiropractic adjustment and, in some cases, can be devastating, said Wira. The first signs of stroke may include facial droop, difficulty with language, dizziness, and weakness or numbness on one side of the body. Some people may experience long-term complications, including paralysis, memory loss, vision problems or speech and language issues. Larger clots that cut off blood supply to the back of the brain may have a 90% mortality rate, Wira said.

Chiropractic neck adjustments aren’t the only potential cause of arterial dissections. They can also occur after experiencing whiplash in a car crash or riding a roller coaster, or even from severe coughing or vomiting. It’s rare for this to happen — we’ve all coughed intensely at some point and been totally fine — but “really anything that puts a lot of stress on the neck” can increase the risk for a dissection, Croll said.

There’s some research suggesting that chiropractic care doesn’t directly cause strokes, but that certain patients who go to the chiropractor for headache and neck pain may already have a dissection — hence the pain — that heightens their risk for stroke. “People who are predisposed to artery dissection, and in turn strokes, are more susceptible to trauma from cervical adjustments,” said Anjali Agrawal, a family chiropractor and founder of Back in Balance Health in Los Altos, California.

The overall risk of having a stroke after visiting the chiropractor is thought to be low, but the evidence is all over the place.

One paper estimated the risk of serious adverse events, including stroke, to be anywhere from 0.05 to 1.46 per 10 million manipulations among Medicare recipients ages 66 to 99. A report published in 2018 found that 1 in 48 chiropractors have had a patient experience a vertebral artery dissection. Older research suggests that people under the age of 45 who experienced a posterior circulation stroke were five times more likely to have recently visited a chiropractor. “The bottom line is, we really don’t know how common this is after going to the chiropractor,” said Croll.

What we do know is that it can happen to anyone. Certain people are more at risk, including those with connective tissue disorders — like Marfan syndrome or Ehlers-Danlos syndrome — and people who have anatomical abnormalities in their neck or a recent injury or illness. Sometimes, there is no clear risk factor.

“I have seen patients, including young patients, who have presented with strokes after having had neck manipulations from chiropractors,” Wira said. Croll, who sees multiple stroke patients every day, said she treats a couple of patients each year who’ve had a stroke after receiving a neck manipulation from a chiropractor.

This doesn’t mean you need to write off visits to the chiropractor, but you may want to take a few extra steps to minimize your risk.

First, find a chiropractor who has had proper training, adheres to current guidelines and is aware of the potential risks. It can also help to find a provider who uses low-force techniques. Many chiropractors, including Agrawal, use gentle techniques that don’t involve high-velocity, forceful adjustments of the neck.

Talk to your chiropractor about your concerns, and tell them about your medical history and preexisting conditions. Share your preferences and consider asking them to use a gentler approach or to skip the neck altogether, especially if you have any risk factors. Your chiropractor will use this information to tailor their approach to your needs, Agrawal said.

On top of that, make a point to be rested and well hydrated ahead of your appointment. “Dehydration and fatigue can impact the elasticity of blood vessels,” Agrawal added.

Lastly, check in with your doctor. Let them know that you want to see a chiropractor, and discuss any extra precautions that you may need to take.

“As long as people are keeping their doctors in the loop about what they’re doing, I don’t think there’s anything wrong with going to the chiropractor,” Croll said. “It’s just that when you go, you want to be smart about the risks you’re taking.”