Are Neck Adjustments Safe? What the Stroke Research Actually Found

Short answer: the biggest population study on this question followed every stroke of that type in Ontario for nine years, across more than 100 million person-years, and found no excess risk of stroke after chiropractic care compared with a visit to a family doctor. People who had this kind of stroke were more likely to have seen a chiropractor shortly before it, and just as likely to have seen their GP. The most likely explanation is that the stroke was already starting, causing the neck pain and headache that sent them to somebody in the first place.

It is the question we get asked most often and the one people are most embarrassed to ask out loud. So here is the whole answer, including the parts that are not flattering.

Where the fear comes from

You have probably read a headline: a neck adjustment tears an artery in the neck, and the person has a stroke. The artery in question is the vertebral artery, which runs up through the bones of the neck to the back of the brain. When its inner wall tears, a clot can form and travel. That is a vertebrobasilar stroke. It is rare, it is real, and it is serious.

The question is not whether that kind of stroke exists. It is whether chiropractic care causes it. That has been studied properly.

Ontario: 818 strokes, nine years

Researchers took every hospital admission for a vertebrobasilar stroke in Ontario, Canada, between April 1993 and March 2002 — 818 cases, drawn from a population that adds up to more than 100 million person-years. They matched each case against four controls and looked back at who those people had seen before the stroke. The study was published in Spine, an orthopaedic journal, not a chiropractic one.

Here is what they found:

• Under 45, people who had this stroke were about three times more likely to have visited a chiropractor beforehand. They were also about three times more likely to have visited their family doctor.
• Over 45, there was no association with chiropractic care at all. The association with family-doctor visits was there at every age.
• In the 30 days before the stroke, 4% of those 818 people had seen a chiropractor. 53% had seen their doctor.

The authors’ own conclusion: “no evidence of excess risk of VBA stroke associated with chiropractic care compared to primary care.”

The part most people skip

That “three times more likely” figure is real, and we are not going to hide it. The point is what sits next to it: the exact same signal shows up after a visit to a doctor who never touched anyone’s neck. Nobody reads that and concludes that GP waiting rooms cause strokes.

The explanation the researchers give is the one worth remembering. A tear in the artery does not announce itself as a stroke. It announces itself as neck pain and headache — often severe, often unlike anything the person has had before. So the person goes to whoever is nearest: their doctor, or their chiropractor. The stroke follows days later, and whoever they happened to see gets the blame.

A second check, on a million people

A different team looked at 1,157,475 Medicare patients aged 66 to 99 who had neck pain, comparing what happened after a chiropractic visit with what happened after a primary-care visit.

Within seven days, the rate of any stroke was 1.2 per 1,000 after a chiropractic visit and 1.4 per 1,000 after a primary-care visit. Within 30 days it was 5.1 versus 2.8 — this time the chiropractic figure was the higher one. The authors described both differences as being of doubtful clinical significance, and described the rate of vertebrobasilar stroke specifically as extremely low.

We show you both numbers because the honest version includes the one that does not suit us.

What these studies cannot tell you

They are population studies, not trials. They cannot prove that an adjustment has never injured an artery in anyone, anywhere, and we will never claim that. What they can show is that when you look at an entire province over nine years, or at over a million older adults, the risk signal used to warn people off chiropractic care shows up identically after a routine trip to the doctor.

Rare events are hard to study precisely because they are rare. That is the honest limit, and it cuts both ways.

What we do about it at illumINNATE

Safety is not a statistic, it is a process:

• We take a full health history before we touch you. Your initial assessment starts with a consultation, a digital posture analysis, an INSiGHT nervous-system scan and a chiropractic exam. The adjustment comes after all of that, not before.
• The technique is chosen for you. A specific, gentle adjustment can be delivered with a drop table, an instrument or our hands. Not every spine needs the same input, and we say so.
• If it is not a chiropractic case, we tell you. If your history or your exam points somewhere else, the right answer is a referral, not an adjustment.

When not to see a chiropractor

Go to A&E or call 112 instead — do not wait for an appointment with us or with anyone else — if you have:

• a sudden, severe neck pain or headache unlike any you have had before, described as the worst of your life
• dizziness or vertigo that comes on suddenly, unsteadiness, or difficulty walking
• double vision, slurred speech, difficulty swallowing, or drooping on one side of the face
• weakness or numbness on one side of the body

These are the warning signs of a stroke or an artery tear in progress. They need a hospital, immediately. Any chiropractor worth seeing will tell you exactly the same thing.

And does chiropractic care actually help a painful neck?

Fair question, once safety is settled. A trial published in the Annals of Internal Medicine in 2012 split 272 people with neck pain into three groups for 12 weeks: chiropractic adjustments, medication, or home exercise with advice. The adjustment group did better than the medication group at 8, 12, 26 and 52 weeks. The home-exercise group did about as well as the adjustment group.

The honest reading is not “chiropractic beats medicine”. It is that for a painful neck, movement outperformed pills over a full year — and that a good chiropractor gives you both the adjustment and the exercises to do at home. Ours do.

Frequently asked questions

Can a chiropractic adjustment cause a stroke? The largest studies find no excess risk compared with seeing a family doctor for the same symptoms. No study can rule out a rare event entirely, which is why the history and exam come first, and why the warning signs above matter.

Does every chiropractic visit involve the neck being adjusted? No. What gets adjusted depends on what your exam and scan show. If you would rather not have your neck adjusted, say so — there are other techniques, and we use them.

Is it safe if I have high blood pressure, take blood thinners, or have osteoporosis? Tell us at the consultation. These are exactly the details that change which technique we choose, which is why the intake asks about them.

Is it safe during pregnancy and for babies? Yes, and the force used is a small fraction of what is used on an adult. See chiropractic during pregnancy and when a baby should first be checked.

The sources

• Cassidy JD, Boyle E, Côté P, et al. Vertebrobasilar stroke and chiropractic care: a population-based case-control and case-crossover study. Spine, 2008;33(4 Suppl):S176-83. PubMed
• Whedon JM, Song Y, Mackenzie TA, et al. Risk of stroke after chiropractic care in Medicare B beneficiaries aged 66 to 99 with neck pain. Journal of Manipulative and Physiological Therapeutics, 2015;38(2):93-101. PubMed
• Bronfort G, Evans R, Anderson AV, et al. Chiropractic adjustments, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Annals of Internal Medicine, 2012;156(1 Pt 1):1-10. PubMed

Still not sure? Bring the question to the consultation — it is a good one, and we would rather answer it in person than have you talk yourself out of care you need. Book an assessment.