Neck pain - nix the neck adjustments?

If you have any experience being treated by a chiropractor, you know their treatment can walk the fine line of physical bliss and sheer terror. I started getting regular chiropractic adjustments when I was 7 years-old. My family believed in alternative medical treatments but not to the point of sounding crazy. I had no idea why I was getting adjusted, I had no idea what a subluxation was, but the wonderful massage after getting twisted up like a pretzel and cracked made it all worth it. Chiropractic may very well be the most controversial branch of medicine. The arguments back and forth seem to be never ending. So let’s get to the bottom of it, are chiropractic adjustments, particularly of the neck, really safe?

Treatment Styles

Many chiropractic treatments consist of very mainstream manual therapy, like that seen with physical therapy. These treatments include massage, joint mobilization and manual stretching. Chiropractic care differs from physical therapy primarily in the emphasis on high velocity joint manipulation. Most chiropractors use a method called “thrusting” where they apply force directly to a vertebra and rapidly take the joint to an end range of motion. This normally results in a “popping” sound and temporary relief in the painful area. Thrusting is said to realign a patient’s subluxation — a displaced vertebra.

Aches and Pains

Many people experience minor pains and headaches following a chiropractic neck adjustment. A body pushed to its limit — in this case an extreme range of motion — will often experience pain later that day or in the days to come. Most of these pains dissipate quickly, leaving the patient feeling much better than before. For some people, however, headaches may follow, and in some cases they can last several days.  In 2007, the scientific journal Spine published a study showing the results of over 50,000 cervical (neck) manipulations; the study found that about 4% of patients experienced light pain and headaches following their adjustment.

Cervical Artery Dissection

Now for the more serious complications that can be caused by cervical manipulations (neck adjustments): Cervical artery dissection (CAD) describes a condition where the carotid or vertebral arteries are stretched to the point where they tear. The vertebral artery is much more likely to suffer injury than other arteries because it wraps around the atlas — the uppermost vertebra. CAD is a common cause of stroke in young people. Car accidents often cause CAD when rapid extension and rotation put the arteries in a compromising position. Unfortunately, when chiropractors adjust a neck, they often use a very similar motion in their efforts to realign subluxations.

The link between chiropractic adjustments and CAD is not a new finding. The first study showing a link between cervical manipulations and CAD was published in 1947. A 2000 study published by the Canadian Medical Association brought this to the mainstream by explaining the link and pointing out that there were two recent deaths attributed to chiropractic neck adjustments. Defenders of chiropractic see things very differently. They will argue that people who have been in car accidents are more likely to see a chiropractor and receive cervical manipulations. Therefore, while it looks like chiropractic care is causing neck injuries, it’s really just that there are a high proportion of people with previous injuries to their cervical arteries getting adjusted. Yet, despite these claims, there is evidence from researchers that spans 60 years indicating the chiropractic has a direct role in causing cervical artery dissection, so I’m reluctant to dismiss all of their work.

The Take Away

I enjoy chiropractic adjustments, but I do not get them often. Chiropractors have been labeled by many to be “quacks” who simply want to take your money. This is true for some, but you will find that to be true even among physical therapists, trainers, nutritionists, and yes, even doctors. Although the risk of suffering a major injury due to cervical manipulation is very low, the risk is still there.  Ask your chiropractor if there are other treatments for your neck besides trusting into extension and rotation. Other options, like traction and soft tissue manipulation, often help patients reach full recovery without the risks of forceful neck adjustments. 

Sources: Canadian Medical Association: Sudden neck movement and cervical artery Chiropractic Philosophy and PracticeOpen Neurologic Journal: Cervical Artery Dissection: Emerging Risk FactorsSpine: Safety of chiropractic manipulation of the cervical spine: a prospective national survey

Originally posted 2013-09-12 13:48:45.


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