Cracking Necks: Is It Safe?

Disclaimer: Here at Champion Physical Therapy, we do not perform chiropractic/osteopathic "adjustments." Instead, we perform osteopractic spinal manipulations, which are similar in practice but use different techniques and carry a different philosophy for clinical decision-making. There are, however, enough similarities between the two schools of practice that we can use the studies below to make good clinical decisions about patient safety even though some of the studies specifically mention chiropractic adjustments.

Spinal manipulations will never be performed without your informed consent at Champion Physical Therapy. You will be properly screened before any manipulation.

To summarize the research below...

Osteopractic spinal manipulation is a very safe and effective treatment option for a variety of musculoskeletal conditions.
You are more likely to spontaneously rupture a vertebral artery by going to your Primary Care Doctor than you are by having a spinal manipulation.
In the few cases where a patient did have serious side effects following spinal manipulation (for example, stroke), it is far more likely that the patient was already experiencing signs/symptoms of the stroke well before the spinal manipulation. The chiropractor may have not properly screened the patient for stroke in this case, and assumed that any neck/headache pain that brought the patient into their clinic was not due to a stroke. In this case the patient should have been sent to the emergency room before any spinal manipulation occurred. This is to say that stroke is correlated with patients seeking out chiropractic care, not that spinal adjustments cause a stroke.

Risk of Vertebrobasilar Stroke and Chiropractic Care.pdf

Current understanding of the Relationship Between Cervical Manipulation and Stroke, what does it mean for the chiropractic profession.pdf

The Risk Associated With Spinal Manipulation an overview of reviews, Nielsen et al.pdf

Cervical arterial dissection: An overview and implications for manipulative therapy practice - PubMedFor those patients presenting with recent onset, moderate to severe unusual headache or neck pain, clinicians should perform a careful history, in particular questioning about recent exposure to head/neck trauma or neck strain. Cardiovascular factors may not be particularly useful indicators of risk …

Microstructural damage in arterial tissue exposed to repeated tensile strains - PubMedWe conclude that cadaveric rabbit arterial tissue similar in size and mechanical properties of that of the human VA can withstand repeat strains of magnitudes and rates similar to those measured in the cadaveric VA during cervical SMT without incurring microstructural damage beyond control levels.

Vertebral artery strains during high-speed, low amplitude cervical spinal manipulation - PubMedSpinal manipulative therapy (SMT) has been recognized as an effective treatment modality for many back, neck and musculoskeletal problems. One of the major issues of the use of SMT is its safety, especially with regards to neck manipulation and the risk of stroke. The vast majority of these accident …

Biomechanical characterization of cervical spinal manipulation in living subjects and cadavers - PubMedWhen performed in cadavers, cSMT tends to be more "aggressive" in terms of all biomechanical indices used to describe cSMT.

Changes in vertebral artery blood flow following various head positions and cervical spine manipulation - PubMedThere were no significant changes in blood flow or velocity in the vertebral arteries of healthy young male adults after various head positions and cervical spine manipulations.

Internal forces sustained by the vertebral artery during spinal manipulative therapy - PubMedSMT resulted in strains to the VA that were almost an order of magnitude lower than the strains required to mechanically disrupt it. We conclude that under normal circumstances, a single typical (high-velocity/low-amplitude) SMT thrust is very unlikely to mechanically disrupt the VA.

Preliminary report: biomechanics of vertebral artery segments C1-C6 during cervical spinal manipulation - PubMedAlthough general conclusions should not be drawn from these preliminary results, the findings of this study suggest that textbook mechanics of the VA may not hold, that VA strains may not be predictable from neck movements alone, and that fascial connections within the transverse foramina and couple …

Atlanto-axial facet displacement during rotational high-velocity low-amplitude thrust: An in vitro 3D kinematic analysis - PubMedDisplacement during the execution of HVLA thrust is unintentional, unpredictable and not reproducible. On the other hand and in accordance with other studies, the displacement induced with the present technique seems not to be able to endanger vital structure on the Spinal Cord and the Vertebral Art …

Effect of selected manual therapy interventions for mechanical neck pain on vertebral and internal carotid arterial blood flow and cerebral inflow.pdf

For more research articles on Osteopractic Spinal Adjustment visit: https://spinalmanipulation.org/osteopractic-research/

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Email taylor@championphysicaltherapy.org