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Chiropractic Neck Manipulation Facts

Chiropractic care is widely recognized as one of the safest, drug-free, surgery-free therapies available for the treatment of back pain, neck pain, headaches, and other musculoskeletalconditions.

Few other therapies can demonstrate a better safety record for the treatment of spinal pain syndromes. Of course, no health treatment is completely free of potential adverse effects. Even common over-the-counter medicines carry a risk.

Fortunately, the vast majority of adverse effects associated with spinal adjustments are typically minor and short lived.


Read the following, in this page, for more information and answers to frequently asked questions:



How safe is a neck adjustment?

Typical neck adjustments carried out by a qualified Chiropractor are very safe and gentle. In each case, the Chiropractor will evaluate the need for the adjustment. Alternative therapies, such as Active Release Technique, can also be used to relieve tension and stress on the neck.

There is a rare risk of stroke or stroke-like symptoms associated with adjustment of the neck. But, you have greater odds of getting hit by lightning, or dying from consuming an aspirin.

The most recent research published in 2001 in the Canadian Medical Association Journal puts the risk at one in 5.85 million adjustments.(1) Reports on the subject over the past 40 years present a range of estimates based on the different research methodologies.

However, all of the published studies to date, agree that the risk is extremely low. Overall, a ratio of one to two cases per million neck adjustments represents a conservative and generally recognized estimate.(2)

That is less than your risk of getting struck by lightning or of dying while skiing or playing soccer.(3) Most chiropractors, during their entire professional lives, do not have a single case of a patient experiencing serious adverse effects.

How does that compare to other risk factors?

There are many risk factors for stroke including blood clotting problems, hypertension, smoking, high cholesterol, use of birth control pills, heart problems and trauma such as sport injuries or blows to the head from an accident. All carry a greater degree of risk than spinal adjustment.

Strokes or stroke-like symptoms are also associated with many normal everyday activities such as cradling a phone between your ear and shoulder during a prolonged conversation, having your hair washed at a beauty parlor, dental procedures, painting a ceiling, and turning your head while driving.

Strokes also occur spontaneously in some people for no apparent reason.

What are the risks for other therapies?

Spinal adjustment is significantly safer than other common therapies for back and neck pain and headache.

Long-term use of non-steroidal anti-inflammatory drugs for pain cause 1,000 serious complications, and 100-200 deaths per million cases.

Surgeries for neck and back pain cause 15,600 cases (4) of paralysis or stroke per million cases, and 6,900 deaths per million. (5)

Is neck adjustment a forceful action?

No, it is not. Neck adjustment is done within the normal range of motion. This normal range is less than what is required to turn you head when backing up a car.

Adjustment of a joint is a highly skilled procedure which requires relatively little pressure. This has been clearly demonstrated in studies to determine the degree of physical stress applied during adjustment.

It is skill, not strength, that is needed to conduct a safe, effective adjustment. It is for this reason that you are encourage to go to a skilled Chiropractor for adjustments, rather than to other professionals who are not adequately trained for this procedure.

Chiropractic education in Canada is an intensive four year program, that occurs after three years of university undergraduate studies. By the time they graduate, Canadian Chiropractors are among the most skilled in the world.

Why has there been media attention focused on neck adjustments?

Attention has been recently directed to neck adjustment by a group of neurologists called the Canadian Stroke Consortium.

The Consortium has, on a number of occasions, publicized alarmist data from an incomplete survey based on a questionnaire. The Consortium has never revealed what method it is using for confirming whether the cases of stroke it reports are in fact associated with neck adjustment.

Until such time as the survey is published in a peer-reviewed medical journal where the survey design and conclusion can be evaluated by medical peers, their reviews and comments should be viewed with skepticism and caution.

Does the medical profession regard neck adjustments as safe and appropriate treatment?

Yes, Most Chiropractors have excellent relationships with physicians and cross refer patients on a routine bases.

Depending on a patient's problems, their care may be co-managed by both a doctor of Chiropractic and a medical doctor. Further evidence of the respect which chiropractors has within the medical community was the presence of Canadian Chiropractors on the heath care team for Canada's athletes at the 2002 Winter Olympics, as well as previous Olympics and Pan Am games.

For further information on the Chiropractic profession and Chiropractic care visit the Canadian Chiropractic Association website at and the College of Chiropractors of Alberta at


  1. Arterial Dissections Following Cervical Manipulation: The Chiropractic Experience, Haldeman S, Carey P, Townsend M. Papadopoulos C, Canadian Medical Association Journal Vol. 165, No 7, 905-906, 2001.
  2. The Appropriateness of Manipulation and Mobilization of the Cervical Spine: A Systematic Review of the Literature, Hurqitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG, Spine 21(15): 1746-1760, 1996
  3. Risk Factors and Precipitating Neck Movements Causing Vertebrobasilar Artery Dissection After Cervical Trauma and Spinal Manipulatin, Haldeman, S. Kohlbeck FJ, Mc Gregor M. Spine 24(8); 785-794, 1999
  4. Conservative Management Of Mechanical Neck Pain: A Systematic Overview and Meta-Analysis, Aker PD, Gross AR, et al. The British Medical Journal, 313: 1291-96, 1996
  5. The Reality and Acceptance of Risk, Dinman JD, Journal of the American Medical Association, 244(1): 1226-1228, 1980
    A Risk Assessment of Cervical Manipulation v. NASIDS for the Treatment of Neck Pain, Dabbs, V, Laluretti WJ, Journal of Manipulative and Physiolocial Therapeutics 18:530-6, 1995 5 ibi

Canadian Medical Association Journal Validates Chiropractic Treatments

Canadian Medical Association Journal (CMAJ), puts the risk of stroke following neck adjustment at 1 in every 5.85 million adjustments.

In fact, the incidence of stroke associated with neck adjustments is so rare, that it was not possible for the researchers to establish a meaningful rate of occurrence despite the high number of cervical adjustments that are performed.

It is estimated, that over a 10 year period, Chiropractors in Canada perform over 134.5 million neck adjustments. During the same 10 year period, only 23 reported cases of stroke could possibly be associated with the treatment. This extremely low occurrence cannot be matched by any other medical procedure.

Lets compare this to these medical statistics in the United States.


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This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health care provider. Please consult your health care provider with any questions or concerns you may have regarding your condition.Any attempt to diagnose and treat an illness using the information in this site should come under the direction of a trained medical practitioner. We accept no responsible for any adverse effects or consequences resulting from the use of any of the suggestions or procedures in this site or related internet links. By using the information in this web site you are confirming that you understand this statement and that you accept all risk and responsibility.

All matters regarding your health should be supervised by your health care provider. All information provided in this site is for the purpose of education, not treatment.

The information provided by or linked to on this site may or may not reflect the opinions of Dr. Brian Abelson. It does not represent the opinions of the Alberta Chiropractic Association or other affiliated associations.