Do Chiropractic Adjustments Cause Stroke?

Study after study over at least the past 15 years has consistently shown that spinal manipulation in the neck is safe. There is no evidence of excess risk of VBA stroke associated chiropractic care

Chiropractic manipulation is one of the safest treatments for spine and pain. There is no excess risk of stroke from Chiropracctic care.

There are rare case reports that the media have picked up and sensationalized, falsely claiming that stroke is caused by neck manipulation and is not safe.

The Safety of Spinal Neck Manipulation

The safety of spinal neck manipulation has been repeatedly reported by many researchers as early as 2010 (Carlesso et al.).

In the medical literature there are rare reports of blood vessel injuries and strokes associated with manipulation of the spine. However, neck manipulation has not been found to cause stroke. Researchers have concluded that spinal manipulation is unlikely to be a cause of stroke.

Serious complications such as stroke are very rare, are estimated to occur in 1 in 3-5 million. 

Mild side effects rarely occur, but may include:

• Worsening of discomfort
• Headache
• Dizziness after the manipulation for a few moments

What Medical Research States:

In 2024, Natalie Pankrath et al. conducted a comprehensive systematic review in the journal Pain Physician to determine the frequency and severity of adverse events after cervical spinal manipulation performed by chiropractors, physiotherapists, and medical doctors.

They concluded that no serious side effects were detected following neck manipulations in all the quality studies available on the topic.

They also stated that it is particularly challenging to study serious adverse effects such as stroke after neck manipulation because it occurs so rarely.

It is interesting that in the past 15 years, there are physiotherapists and medical doctors who have made efforts to learn how to manipulate the spine, when for many years, there was a concerted effort by the medical community to dissuade people from seeing Chiropractors.

This is because of the safety and effectiveness that spinal manipulation has shown in research over time.

Known Risk Factors Associated with Stroke:

Smoking, obesity, undiagnosed hypertension, and some connective tissue disorders are some of the risk factors for dissection of arteries that go to the head and for stroke.

Neck pain and headache are common symptoms of Vertebral Basilar Artery dissection, which commonly precedes VBA stroke.

In the rare cases where a person had a stroke in the hours of weeks following neck manipulative treatment by her medical doctor, chiropractor, or physiotherapist, it is probable that her pain may have been a symptom of an impending stroke.

It has been found that people of all age groups are just as likely to have a stroke reported after seeing their family physician, as they are after having their neck adjusted.

There are times when things occur together in time, but that does not mean that one caused the other.

When Spinal Manipulation is Not Performed:

There are certain conditions that are either contra-indications for neck manipulation or that Dr. Horowitz is not comfortable treating. In these people, the risk of instability in the upper neck can be aggravated by even mild traumas or there is the risk of fractures or subluxations.

Some examples of conditions that you may have where Dr. Horowitz will not perform spinal manipulation (nor PulStar® analysis) of your neck include:

• Rheumatoid Arthritis
• Trisomy 21
• Connective Tissue Disease
• Cervical Spinal stenosis with signs of radiculopathy
• X-ray evidence of congenital fusion in your spine
• Cervical spine surgery

There is no specific test available to screen or diagnose those who are at risk of having vertebral artery dissection.

Dr. Horowitz carefully considers your history and health status when deciding if neck manipulation is appropriate.

You can trust Dr. Horowitz to provide evidence-informed, safe, and effective health care.