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Safety of CHIROPRACTIC manipulation of neck, shoulder.

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Hi there,

I was wondering as a neurologist what your opinion is on the safety of chiropractic neck manipulation for neck/shoulder pain issues?

I know there is some concern over possibility of stroke caused by stretching/tearing an artery. Some studies did not find an increased risk, while others seem to support there could be.

Your thoughts?


Category: Neurologist, Medical

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Category: Pediatric Neurologist
 28 Doctors Online

Thank you for posting your query at
I have noted your concern.
Personally, given a choice, I would not recommend chiropractic neck manipulation.
However, chiropractic neck manipulation is a well researched art, and people trained in it do a good job. As such, there is no increased risk of stroke. Strokes occur in people who are already predisposed, which means they have a narrower artery (vertebral or basilar).
So, if there is no other option of treatment, chiropractic neck manipulation may be undertaken by a trained chiropracter.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Patient replied :

Thank you very much for the response!
May I ask why you wouldn't personally recommend neck manipulation? I may talk to my chiropractor to see if there are other approaches (gentler massage technique or exercises I can do at home).
You mentioned these strokes happen in people predisposed, and I'm assuming there's no way to tell. But from what you're saying, neck manipulation itself, as long as you're not already predisposed, shouldn't increase risk substantially by stretching the artery too much, correct? (And if I do choose to stop, experiencing neck manipulation once, even if it did stretch an artery and it had time to heal, wouldn't put me at any increased risk in the future?)
Thanks much for the information and followup!

Thank you for getting back.
My personal recommendation against manipulation is based on two points- First, there is no method to predict who would get a brain stroke after manipulation, unless we do an MR angiogram of brain (which is not feasible or recommended in most people), Second, there are very few properly trained & experienced people in manipulation of the neck (at least in India).
In any case, if the chiropracter is experienced, you can go ahead. If you are not predisposed, it would not incerase the risk. Also, it would not pose nay risk in the future.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist,

Patient replied :

One last followup and thanks much for your patience and thoroughness!
I understand the risks from what you're describing!
He is quite experienced (20 years and ~260,000 manipulations). I actually had an appointment today so spoke to my chiropractor about my concerns, and he agreed to alter my therapy.
No more direct thrusts, cracking, or head turning of the neck. He used a gentle device called an activator for anything shoulder level or above (it feels a bit like tapping), and the only body parts still subjected to thrusts/cracking are the upper back (all contained to below my shoulder area) and lower back.
Would this remove any potential risk without the MR angiogram being necessary? Is it only the arteries in the neck that are subjected to this type of stretching, but upper/lower back should be safe?

Thank you for getting back.
I agree he is quite experienced and you would be safe in his hands.
There is no need to do MR angiogram in your case.
It is only the vertebral arteries in the neck and lower brain that are at risk. There are no other risks to upper or lower back.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Dr. Sudhir Kumar
Category: Pediatric Neurologist
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
Dr. Sudhir Kumar and 4 other Medical Specialists are ready to help you

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