ADVICE: Is 'cracking' my neck risky?

Neck and spine manipulation can relieve pain, but like all health interventions, it's not without risk.

Maja Begovic 4 minute read September 13, 2021

Chiropractic care has many benefits, but there are risks to be aware of. GETTY

Dear Asking For a Friend,

I used to enjoy going to the chiropractor to be “cracked” — that included my back and neck. I stopped when there was all the hype about how manipulating your neck can be dangerous. Is this something I really need to worry about?

Signed, Stiff Neck


Dear Stiff Neck,

Contrary to popular belief, “chiropractors don’t ‘crack’ anything,” says Dr. Debbie Wright, chair of the Canadian Chiropractic Association. “The noise you sometimes hear that is associated with adjustments is caused by the formation of gas bubbles in spinal joint fluid and when the joint is quickly stretched, you may hear that sound.”

She explains that spinal manipulation, also known as chiropractic adjustments, help to relieve neck and back pain in two primary ways. It improves mobility in the joints of the neck and back thereby improving function, and the adjustment also help decrease pain in the affected tissues by modulating the pain response of the nervous system. Chiropractors also have other tools to relieve neck and back pain, such as stretching and strengthening exercises and advice on how to best manage the problem.

But like all health interventions, chiropractic adjustments have benefits and potential risks associated with them.

The biggest concern is risk of vertebral artery dissection, which is a tear that occurs in the inner lining of an artery that’s located at the back of the neck. This is one of the four major arteries that supply blood to the brain, and if a tear occurs, it can impede blood flow to the brain or allow the blood to enter the arterial wall and form a blood clot, causing a stroke.

“While most adverse events associated with adjustments are minor and short-lived, like temporary soreness after treatment, there is the potential for more rare but serious adverse events if a patient has certain pre-existing underlying health conditions,” says Wright.

But how risky is it?
A 2008 Canadian study found that most patients who suffered a stroke following a chiropractic adjustment had experienced symptoms prior to the treatment. But whether it’s linked to a pre-existing condition or chiropractic treatment, signs to watch for include difficulty speaking and walking, weakness or clumsiness in the arm or leg, vertigo, trouble swallowing and neck pain, all of which require immediate medical attention. Vertebral artery dissection can be treated with aspirin and lifestyle modifications that include avoiding aggressive activities and sports, but getting immediate medical help is critical and can ensure the best possible outcome.

According to the Canadian Chiropractic Association, roughly 7.3 million people suffer from chronic pain. And working from home is making it worse. A recent report suggests that more than half of employees who work remotely are experiencing new aches and pains, including shoulder and back pain. In fact, poor musculoskeletal health is the primary cause of lost-time work injury, costing the Canadian economy nearly $14 billion in productivity losses.

All those body aches and pains prompted 4.7 million Canadian adults to turn to a chiropractor for symptom relief and guidance on muscle and joint injury prevention. And while patient experience may vary, one study found that participants who received chiropractic care for a period of six weeks reported improvement in pain and movement.

While relief from aches and pains can be achieved with chiropractic treatment, caring for yourself at home is equally important. If you spend long hours slumped over your computer, consider putting a pillow behind your lower back to help improve your posture. Also, ensure your monitor is at eye level and hold your head up to avoid the dreaded tech neck. If you’re on your feet throughout the day, try remedies such as orthotics, stretching exercises and alternating between hot and cold compresses. Losing weight and stretching can also help manage and prevent symptoms.

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