Answers to Questions about Chiropractic:
How Dangerous Are Frequent Neck Manipulations?

Samuel Homola, D.C.

Question

I read your article about chiropractic subluxation theory at the Medscape web site. I have been receiving deep tissue massage from a licensed chiropractor/massage therapist who also has a degree in sports nutrition. She attended the Los Angeles Chiropractic College and seems conservative in her approach overall. She also refers patients to me for nutrition counseling, acknowledging that nutrition is not her specialty.

My question for you regards her adjusting my neck twice per month. I provide individual nutrition counseling in a setting where I sit for 8 hours or more, 2 days per week. Because of this, I have chronic muscle tension in my shoulders, upper back, and neck regions. At the end of my 1-hour massage twice per month, she adjusts my neck with me laying on my back. She starts at the base of my neck for the adjustment, so I do not believe she is adjusting at the top of my cervical column. Typically only one side of my neck will "crack," and she does not force the other side if it does not pop right away. I do suffer from menstrual migraines 1-2 times per month, and I take Imitrex and Midrin for pain control. I have received an adjustment from her in the past while on the medication for a migraine, and it always makes me nervous about the risk of stroke.

Is it dangerous for me to continue having her neck adjustments twice per month after massage; and is it dangerous for me to have them while on Imitrex? I also suffer from sciatica, and her deep tissue massages in my lower back area (long with daily exercise and stretching) have enabled me to not take any medications for pain control.

Answer

Whereas anecdotal evidence and studies of the literature indicate that cervical manipulation may be effective in relieving tension headache, a 1998 study published in the Journal of the American Medical Association concluded that neck manipulation "does not seem to have a positive effect on episodic tension-type headache."

Because of the risk of cervical manipulation damaging neck arteries to cause a stroke, it might be safer to rely upon massage and neck traction to relieve your headache. Since Imitrex and Midrin tend to raise blood pressure, I would not recommend the use of neck manipulation in combination with these drugs.

I certainly would not recommend regular, routine use of neck manipulation as a preventive measure. Forced rotation of the head past 50 degrees tends to place a strain on the vertebral arteries at the atlas-axis level and may damage weak blood vessels, which would be especially hazardous while taking drugs that affect vascular structures.

The pop you hear and feel when your neck is adjusted does not mean that you have misaligned vertebrae; it is simply cavitation produced when joint surfaces are forcefully separated to cause a vacuum that pulls in nitrogen gas to fill the space. This is similar to what happens when people "crack" their knuckles.

While stroke caused by neck manipulation is uncommon, the problem is serious enough to be a valid cause for concern. Neck manipulation should be done only when specifically indicated and absolutely necessary—and only then with informed consent. Quackwatch has a detailed article on this topic.

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Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient's Guide provides an incisive look at chiropractic's history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.

This page was posted on February 22, 2002.