- Neck pain: 3 ways chiropractic care can help!
- Chiropractic Care for Neck Pain
- Do acupuncture, massage and chiropractic work for neck or back pain?
- Chiropractic for Neck Pain A natural, drug-free way to avoid and relieve neck pain.
- Understanding neck pain and how you could help relieve it with routine chiropractic care.
- When to See a Chiropractor for Neck Pain
- How to Manage Your Neck Pain at Home
- When Should You See a Chiropractor for Neck Pain?
- What Causes Neck Pain?
- How Can Neck Pain Be Prevented?
- How safe are the vigorous neck manipulations done by chiropractors?
- Gentle Chiropractic Techniques for Neck Pain
- Common Gentle Chiropractic Techniques
- Gentle Chiropractic Mobilization vs. Adjustment
Neck pain: 3 ways chiropractic care can help!
As students get back into their studying routine this back to school season, they may find that the increased time spent reading and doing computer work, in addition to higher levels of stress, may cause neck pain.
Neck pain is a common problem with many possible causes. Poor posture, hunching over a computer, arthritis, whiplash, and muscle strain from simple things like reading in bed or grinding your teeth can all trigger neck pain. When your neck muscles become tired and strained, pain may be the first symptom.
Thankfully, there are several things you can do to help. Self-therapy is just one method, and it is often best practised in combination with manual therapy. Here are three forms of self-therapy techniques your chiropractor might prescribe for you to do at home to help relieve your neck pain:
1) Stretch: There are a few muscles that are commonly associated with pain in the upper back and neck. Here are a couple of stretches that you can do throughout the day to help decrease your pain.
|Stretch #1: Sitting or standing with a relaxed posture, keep your shoulders down and bring your left ear to your left shoulder. You should feel the stretch on the right side of your neck. Repeat the stretch on the other side and hold the stretch for 10 seconds, for a total of three repetitions per side.|
|Stretch #2: Sitting or standing with a relaxed posture, keep your shoulders down and tilt your head as far forward as you can, then align your right eye with the outside of your left knee. Use your left hand on your head to create more of a stretch. You should feel this stretch on the right side of your upper back. Repeat the stretch on the other side and hold the stretch for 10 seconds, for a total of three repetitions per side.|
|2) Strengthen: A simple exercise you can do at home to help with your neck pain is chin tucks. Chin tucks work on strengthening the deep neck muscles. This exercise can be performed standing or laying down. If you are standing, ensure that you are standing with a neutral posture, then actively pull your chin back, as if to create a double chin. If laying down, gently press the back of your head into the pillow, creating a double chin. Hold either of the variations for 10 seconds and repeat three times.|
3) Most importantly…keep moving!
It is important to make sure that you don’t stay in one position for too long; sitting or standing. If your day involves prolonged sitting, make sure to stand up and take walking breaks. If your job involves prolonged standing, try to take sitting breaks throughout the day and also ensure that you take walking breaks. Movement is key! You can also download the Straighten Up Canada app for daily exercises to help keep you moving.
In rare cases, neck pain can be a sign of something serious. Seek immediate attention and tell your chiropractor if your neck pain is accompanied by severe headache, shooting pain in your shoulder, or arm, numbness or loss of strength in your arms or hands, trouble speaking, swallowing or walking, blurred vision or loss of balance.
When should I consider chiropractic care?
If you experience neck pain, consult a chiropractor for an assessment. Your chiropractor will recommend a course of treatment specific to you which may include spinal adjustments, joint mobilization, muscle release techniques, muscle stimulation, therapeutic exercises, and lifestyle advice. Most people respond well to treatment and get back to their regular activities faster than waiting it out.
For more information, please consult with your local chiropractor.
“There is a time and place and certain conditions when chiropractors would be helpful,” said Nottigham, adding that she didn’t think her chiropractor caused the problem. “I have not seen one since.”
According to Dr. Cain Dimon, physician director of the center for pain medicine at William Beaumont Hospitals in Royal Oak, Mich., spinal manipulation may be appropriate only after patients receive a full physical exam to detect the problem and undergo other types of treatments to relieve the pain first.
“I certainly don’t dismiss chiropractic manipulation,” said Dimon. “It can certainly help in some cases lower pain.”
Overland said it’s unlikely that a chiropractor would perform a spinal manipulation without first knowing the exact cause of pain.
“If a person has a herniated disc, this would’ve been diagnosed, said Overland. “Usually chiropractors do a full orthopedic and neurologic examination.”
In fact, there are some cases where manipulation may exacerbate the pain, said Dimon.
For some experts, the problem with spinal manipulation is that it is has become an overpromising treatment for conditions outside the physiological realm of the technique. For years, chiropractors have faced criticism for claiming their practices work to cure a wide variety of ailments, including asthma and cancer.
“It’s hard for me to understand physiologically how that would work,” said Dimon, who cautioned against undergoing treatments without a physician recommendation.
According to Overland, the lingering controversy over spinal manipulation has less to do with the data concerning its safety or efficacy, and more to do with the resounding consensus by many conventional medical doctors spanning decades that suggests chiropractors are not an equal part of the medical community.
“There’s still a lot of residual bias against the profession,” said Overland. “Yes, there’s risk of every medical procedure, but we need to move away from health in a bottle.”
The medical community should place a larger emphasis on understanding chiropractic techniques, he said.
“What’s lacking is really good research is how spinal manipulation is helping other types of chronic conditions,” said Overland.
Chiropractic Care for Neck Pain
Chiropractic care is a non-surgical treatment option that may help reduce your neck pain and related symptoms. Listed below are some of the different types of neck (cervical) conditions that Doctors of Chiropractic (DC) treat:
- Cervical intervertebral disc injuries that don’t require surgery
- Cervical sprain injuries
- Degenerative joint syndrome of the neck (eg, facet joints)
- Facet joint sprain
How Does a Chiropractor Diagnose Neck Pain?
Your chiropractor will evaluate your spine as a whole because other regions of the neck (cervical), mid back (thoracic) and low back (lumbar) may be affected as well. Along with treating the spine as a whole, chiropractors treat the “whole person,” not just your specific symptoms. He or she may educate you on nutrition, stress management, and lifestyle goals in addition to treating your neck pain.
Before deciding which approach to try for your pain, the chiropractor will do a thorough examination to diagnose the specific cause of your neck pain.
He or she will determine any areas of restricted movement and will look at how you walk as well as your overall posture and spinal alignment. Doing these things can help your chiropractor understand your body mechanics.
In addition to the physical exam, you’ll also go through your past medical history with the chiropractor, and he or she may order imaging tests (eg, an x-ray or MRI) to help him or her diagnose the exact cause of your neck pain.
All these steps in the diagnostic process will give your chiropractor more information about your neck pain, which will help your chiropractor create a treatment plan customized for you.
Your chiropractor will also rule out a neck pain condition that will require surgery—if he or she believes your neck pain would be better treated by surgery, then you’ll be referred to a spine surgeon.
Chiropractic Treatments for Neck Pain
Your chiropractor may use a combination of spinal manipulation, manual therapy, and other techniques as part of your treatment plan for neck pain.
Below are some spinal manipulation techniques your chiropractor may use.
- Flexion-distraction technique is a gentle, hands-on spinal manipulation that involves a pumping action on the intervertebral disc instead of direct force.
- Instrument-assisted manipulation uses a hand-held instrument to allow your chiropractor to apply force without thrusting into the spine.
- Specific spinal manipulation helps restore joint movement using a gentle thrusting technique.
Your chiropractor may also use manual therapies to treat your neck pain.
- Instrument-assisted soft tissue therapy uses special instruments to diagnose and treat muscle tension.
- Manual joint stretching and resistance techniques can help reduce neck pain and other symptoms.
- Therapeutic massage can help relax tense muscles.
- Trigger point therapy is used to relieve tight, painful points on a muscle.
Other therapies may also be used to ease neck pain symptoms.
- Inferential electrical stimulation uses a low frequency electrical current to stimulate neck muscles.
- Ultrasound sends sound waves into your muscle tissues to help stiffness and pain in your neck.
Therapeutic exercises may also be recommended—these can help improve overall range of motion in your neck and prevent neck pain from progressing.
The treatments listed above are simply examples of possible chiropractic treatments for neck pain; your actual treatment plan will depend on your diagnosis. Your chiropractor should thoroughly explain your treatment options so that you know what will happen.
- Haldeman S. Principles and Practice of Chiropractic. York, PA: McGraw-Hill; 2005.
Do acupuncture, massage and chiropractic work for neck or back pain?
If you have persistent neck or back pain, you might be considering acupuncture, massage or chiropractic — therapies often touted to relieve such chronic discomfort.
Do they work? Are they safe? Consumer Reports spoke to experts and reviewed the research to find out.
The founder of modern chiropractic care, a 19th-century Iowan, believed that chiropractic manipulation — or “realigning” the spine by pressing on its joints — could cure all manner of maladies. But most chiropractors focus on skeletal and muscular problems, especially low-back, neck and shoulder pain, and related headaches.
Chiropractors (along with some osteopathic physicians and physical therapists) perform millions of spinal manipulations (“adjustments”) each year. And some studies suggest that they can help diminish pain. A 2011 review of 26 studies found that for chronic low-back pain, manipulation reduced pain in the short term at least as much as exercise and even pain relievers.
“The bad news is that for chronic, persistent back pain, even the best therapies result in only mild to moderate relief,” says Roger Chou, a professor of medicine at Oregon Health & Science University, who studies back pain. As for neck pain, a study of 181 people published in the Annals of Internal Medicine found that getting regular chiropractic care (about once per week for 12 weeks) could lessen discomfort better than acetaminophen and nonsteroidal anti-inflammatory drugs.
“For chronic backache or neck pain that is not accompanied by symptoms requiring medical attention — such as urinary or intestinal problems or weakness, numbness or tingling in an arm or leg — considering chiropractic manipulation seems reasonable,” says Consumer Reports’ chief medical adviser, Marvin M. Lipman. But it isn’t risk-free. “It can cause temporary headaches and, rarely, serious problems such as worsening the pain of a slipped disk,” he notes.
Documented in early Egyptian tomb paintings and Chinese writings from as far back as 2700 B.C., massage involves a range of techniques for rubbing the body to relieve muscle tension and pain. For example, Swedish massage employs long strokes and kneading movements, and deep-tissue massage uses focused, intense pressure in tight or painful areas.
Limited research suggests that massage therapy might ease low-back pain. Take, for example, a 2015 review of 25 small to midsize clinical trials. Researchers with the independent Cochrane Library found that among people with low-back pain lasting more than four weeks, massage provided better relief than such treatments as lightly touching the skin.
Massage therapy also appeared to relieve discomfort better, on average, than treatments including acupuncture, traction and relaxation exercises. Most important, when compared with no treatment or a placebo treatment, massage improved functions such as walking ability, sleeping and other important components of daily life.
So, how might massage ease discomfort? Scientists haven’t pinpointed a mechanism, but they think it might stimulate nerves that mute pain signals. Another theory suggests that massage may trigger the release of pain-reducing hormones called endorphins.
“Trying massage for back pain probably won’t hurt, and might help,” Lipman says. But if you try it, tell your practitioner beforehand about medical conditions you have and medicine you take.
This traditional Chinese technique uses thin needles that are inserted into the body at specific spots called acupoints. It is based on the belief that blocked chi, or energy, causes pain and that stimulating some of our more than 300 acupoints, each believed to affect a specific body part or organ, can unblock energy and relieve pain.
A number of people who use acupuncture for chronic pain report benefits. For example, an analysis of 29 studies with a total of 17,922 participants with back and neck pain, osteoarthritis, chronic headache and shoulder pain found that people with those conditions experienced significantly more relief with acupuncture than those who had no treatment. People also reported less pain after real acupuncture than they did after fake acupuncture (for example, with needles placed in spots that were not acupoints), but the differences were small.
One possible reason for the benefits of acupuncture: Studies show that it causes us to release those feel-good endorphins, which suppress pain. “Acupuncture, real and sham, also might make you feel better simply because you feel cared for or because you expect it to work — the placebo effect,” Lipman says.
For back and neck pain, acupuncture is safe as long as sterile needles, such as single-use disposables, are used by a trained practitioner. But skip it for conditions other than pain; there’s no conclusive evidence that it will help.
Copyright 2016. Consumers Union of United States Inc.
For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.
Chiropractic for Neck Pain
A natural, drug-free way to avoid and relieve neck pain.
Understanding neck pain and how you could help relieve it with routine chiropractic care.
What is Neck Pain?
Acting as a bridge between your head and your torso, which allows for motion of your head, your neck is made up of seven vertebra and is supported by many muscles and ligaments. Neck pain most often occurs when the joints, muscles and ligaments in the neck become irritated or inflamed.
Neck pain can range from minor and easily ignored, to excruciating and debilitating. When combined with other symptoms it can also indicate immediate medical attention is needed. Common symptoms of neck pain include:
- Stiff neck with limited range of motion
- Concentrated sharp or stabbing pain
- General soreness or tenderness
- Radiating pain, that can eventually lead from the neck to shoulders, arms, fingers and head
Although everyone experiences neck pain now and again, it is not something that should be tolerated. Approximately 17 percent of the adult population is suffering from neck pain and discomfort at any given time. In many instances this is caused by sleeping in an abnormal position, poor posture, falling or injuries from sport or whiplash. In rare cases, it can be caused by growth abnormalities, infections, tumors and even cancer.
In any event, neck pain can be serious and should be attended to immediately.
How Can Chiropractic Care Help Those with Neck Pain?
Chiropractic care can be a great way to manage and relieve swelling and discomfort caused by neck pain. Routine chiropractic care provides patients with neck pain a safe, non-invasive, non-addictive alternative to prescription medications or over-the-counter pain medications (OTCs), which are commonly prescribed to patients to help them manage their pain and swelling.
Chiropractors deliver a gentle, non-invasive, non-addictive therapy, known as a chiropractic adjustment. Chiropractic adjustments reduce joint restrictions or misalignments in the spine and other joints in the body in an effort to reduce inflammation and improve function of both the affected joint and nervous system. By increasing joint mobility and improving your nervous system function and spinal health, your body has the ability to better manage the discomfort in the neck.
Below are some of the health benefits chiropractic care and chiropractic adjustments can provide patients with neck pain:
- Reduced pain and discomfort
- Decreased inflammation
- Improved range of motion
- Improved flexibility
- Increased activity and lifestyle
To see if chiropractic care is right for your condition, the chiropractors at The Joint Chiropractic will perform a consultation, examination and if necessary, refer you out for diagnostic imaging such as x-ray or MRI. Based on the findings of our chiropractic exam and consultation, your doctor of chiropractic may elect to co-treat your neck pain with other healthcare professionals including massage therapists, physical therapists or other primary care physicians.
To find a local chiropractor and to learn more about how chiropractic care can help those suffering from neck pain, contact or visit one of our chiropractic offices today, to speak with a licensed doctor of chiropractic.
The information, including but not limited to, text, graphics, images and other material contained on this page are for informational purposes only. The purpose of this page is to promote broad consumer understanding and knowledge of the benefits of chiropractic care. It is not intended to provide or be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your chiropractor, physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this page.
- You’re feeling pain or numbness down into your shoulder, arm, or leg. You might have suffered a spinal cord injury or a herniated (slipped) disk and possibly require a neurologist or neurosurgeon. You may need to go to the emergency room if the discomfort is severe.
- Your neck pain is accompanied by fever, headache, or vomiting, or if you find yourself wincing at light. You might have meningitis, a serious infection of the membranes surrounding the brain and spinal cord. If meningitis is possible, you need to go to the emergency room immediately.
Also, keep in mind that your neck pain could be caused by other medical conditions like arthritis or fibromyalgia. Muscle relaxants and other medications prescribed by your doctor might be better able to alleviate pain in these instances than chiropractic.
By restoring mobility in your joints, chiropractic offers neck pain treatment that aims to fix the source of the pain rather than just treat its symptoms. This no-drug, no-surgery approach may be the answer you’ve been looking for.
Everyone gets a stiff neck once and awhile. Right? It might happen first thing in the morning if you slept wrong. Or it might be at the end of a long workday after you’ve finished an especially stressful project.
You turn your head from side to side, and your neck really hurts.
There’s a big difference between a stiff neck and one that hurts so bad that it makes your head spin, but how do you know when it’s “bad enough” that it’s time to see a chiropractor for neck pain?
When to See a Chiropractor for Neck Pain
First off, there are a few things you can try at home to help alleviate the pain.
How to Manage Your Neck Pain at Home
Cold can reduce swelling to an area that is inflamed. Hold a cold pack or a bag of frozen vegetables wrapped in a towel on your neck. A good rule of thumb is 20 minutes off, 40 minutes on and then repeat.
Check Your Pillow
Make sure you use a firm or extra firm pillow and sleep on your back or side. If your pillow is too flat, it forces your neck to bend in an unnatural position. After a long (or even short) night’s sleep, the muscles in your neck may be so stretched, you’re guaranteed to have a rough morning!
Try Neck Exercises
Light neck stretches can help to loosen stiff muscles. You may want to gently tense your neck muscles as you look up and down and then from side to side.
Be careful not to over-extend your neck beyond its normal limits, though, or you may do more harm than good.
Avoid Driving If You’re Unable to Turn Your Neck Past Your Shoulder
Driving in traffic, especially in heavy traffic or when you’re backing up, requires you to look over your shoulder to see behind you. If your neck is stiff, restricting your ability to look over your shoulder, it could impair your ability to drive safely.
Driving may also require you to turn your neck quickly from side to side. If you have neck pain, this may overstretch your neck and cause severe pain.
It’s best to avoid driving until your neck’s normal movement is restored.
When Should You See a Chiropractor for Neck Pain?
While there are several things you can do at home to help relieve your neck pain, it’s important to know when it’s time to see a chiropractor for neck pain.
Chiropractors specialize in treatment for neck pain. After a physical exam and X-rays, they help to restore motion to stiff joints through a chiropractic treatment plan that usually includes chiropractic adjustments, specific neck exercises and physiotherapy.
See a chiropractor for neck pain if…
- Your neck pain or stiffness does not improve after a few days
- You cannot look to the right or left without severe neck pain
- You feel like you must use over-the-counter pain medications just to make it through the day and are using it regularly to treat your neck pain
- You’re worried that your neck pain may have a serious cause
- Your neck pain started in the neck but has moved to numbness or tingling in your hands or wrists
- Your neck pain started within a few days of a car accident
- Your neck pain is worse when you first wake up in the morning but then begins to feel a little better as the day progresses
Your chiropractor will conduct a thorough consultation and examination – asking you questions about your symptoms, the history of your neck pain, what types of movement make it worse and which things make it feel better.
During the exam your chiropractor will check to see how well you move your neck. He will look for tenderness or numbness and tingling in your arms or hands.
Seeing your chiropractor for neck pain is always a good choice if you are aware of a specific movement (abnormal motion) that resulted in neck pain such as lifting, falling or a whiplash injury.
Injuries resulting from abnormal motion often cause muscles to become overextended and the vertebra in our neck to shift out of alignment.
Through chiropractic therapy your chiropractor can re-align your vertebra and restore normal motion in your neck.
What Causes Neck Pain?
Your neck is made up of vertebrae, and between each of the vertebra are nerves and discs (gel-like pillows that provide a cushion between each vertebrae).
If one or more of your vertebra shift out of alignment, they can crowd or “pinch” the nerves that run between them causing neck pain.
Vertebrae Can Shift Out of Alignment When…
- You consistently have poor posture (such as sitting hunched over your phone all day)
- Your neck is stuck in an awkward position for a long period of time (such as painting your ceiling)
- You continually sleep on your stomach or use a flat pillow
- Your neck is forced beyond it’s normal range of motion (like if you fall off a ladder or get whiplash from a car accident)
Whiplash is one of the most common injuries to the neck. It occurs when the neck experiences a sudden movement forward and backward or from side to side.
This sudden movement overstretches and tears the tendons and ligaments in the neck.
How Can Neck Pain Be Prevented?
- Maintain good posture when your sit or stand
- Move your computer monitor to eye level
- Change your habits. Take micro-breaks throughout your day, especially if your job requires that you sit for long periods of time – or if you must take a long ride in the car
- Use a firm pillow and sleep on your side or on your back
- Learn to recognize your signs of stress and take steps to relieve stress in your life on a regular basis
- Try regular exercses throughout the day and each week to maintain proper movement in your neck.
Chiropractors specialize in neck pain treatment options. The 12 doctors at Fulk Chiropractic have provided treatment to Olathe, Overland Park, Lenexa and the Kansas City Metro area for over 30 years.
Open 7 Days a Week they are in-network with every insurance plan in the Kansas City area. Most insurance plans have a chiropractic benefit. Contact our office at 913-764-6237 to speak with one of our experienced doctors or schedule an appointment online.
How safe are the vigorous neck manipulations done by chiropractors?
The chiropractor had just worked on Lynne Beliveau’s neck when she became dizzy, unable to see or move. Rushed to the hospital, Beliveau had a shunt inserted to relieve pressure caused by swelling in her brain. The Ashburn woman suffered a series of strokes and today, eight years later, the 41-year-old mother of three suffers from constant vertigo.
Elizabeth Haran Caplan knew she was in trouble seconds after a chiropractor in Oklahoma City manipulated her neck. The room got dark and she felt dizzy. Because of her years of service as a combat medic in Kosovo and Somalia, she knew what was happening and yelled, “Stop. I’m having a stroke.” More than a decade later, she is blind in her left eye and has problems swallowing without choking due to paralysis of one side of her throat.
Approximately 20 million Americans visit chiropractors each year, according to the American Chiropractic Association, seeking relief from back pain, neck pain, headaches, sinus problems, ringing in the ears and more. For many, the manipulations provide relief. But one of the techniques chiropractors use, called cervical neck manipulation or “cracking the neck,” has raised concerns that it can cause serious harm.
“I have jumped out of airplanes, escaped bullets in Somalia,” said Haran Caplan, 47, who retired from the Army nine years ago as a lieutenant colonel. “Who knew the most dangerous place I would put myself would be on a chiropractor’s table?”
Neck and spine
David Walls-Kaufman, a District chiropractor who has practiced for more than 30 years, said every patient comes with “two neurological snags,” or problem areas: the neck and the spine. “It’s important to work on the neck if we are going to cure their problems,” he said. Walls-Kaufman sits on the guidelines committee of the national Council on Chiropractic Practice, which describes its mission as providing evidence-based guidelines that “serve the needs of the consumer and are consistent with ‘real world’ chiropractic practice.”
Evidence of the effectiveness of chiropractic manipulation is inconclusive, in part due to a lack of large, rigorously designed studies. Some studies suggest that spinal manipulation may be helpful for lowering blood pressure, dealing with some headaches, helping colicky infants, limiting migraines, easing some types of lower back pain. Others, however, have raised concerns specifically about the sudden powerful thrusts used in cervical neck manipulations and the possibility that they might tear the carotid or vertebral artery leading to the brain. Such tears can cause a blood clot that travels to the brain, causing a stroke.
A 2010 study of deaths after spinal manipulation found 26 published cases, and seven unpublished ones, mostly due to a tear, or “dissection of a vertebral artery,” and suggested that many more cases had not been reported. A 2007 survey of adverse effects published in medical journals between 2001 and 2006 found that “spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke.” It noted that “survey data indicated that even serious adverse effects are rarely reported in the medical literature.” A 2013 survey of 43 studies conducted between 2001 and 2011 found 707 incidents of stroke associated with cervical spinal manipulation therapy, but the authors said that understanding such incidents was hampered by inadequate reporting.
The American Chiropractic Association says that “neck manipulation is a remarkably safe procedure. While some reports have associated upper high-velocity neck manipulation with a certain kind of stroke, or vertebral artery dissection, recent evidence suggests that this type of arterial injury often takes place spontaneously, or following everyday activities such as turning the head while driving, swimming, or having a shampoo in a hair salon.”
Stephen Perle, a spokesman for the American Chiropractic Association, said, “There is no such thing as ‘chiropractic stroke,’ any more than there is ‘unhappiness heartburn.’ There are strokes and VAD that produce strokes. The name alone defines causation when that is not known,” since many people go to chiropractors when they have neck pain that may be have turned into a stroke without manipulation.
Perle said that strokes after a cervical manipulation are “exceedingly rare” and that further studies are needed to prove any connection.
Perle and other chiropractors cite a 2008 Canadian study that found that of those who had strokes following neck manipulation, most had already been having symptoms suggestive of a stroke.
Felipe Albuquerque, a neurosurgeon in Phoenix who has studied stroke injury after neck manipulation, said that assertions that those who suffer tears in their neck arteries would have had a stroke regardless of the treatment suggest an “uncanny coincidence.” He believes the patients that he has seen who had strokes following chiropractic manipulation had either a new arterial injury or one made worse by the manipulation.
“The epidemiology of these injuries is almost impossible to ascertain,” Albuquerque and others wrote in a 2011 study in the journal Neurosurgery. “Studies suggest their incidence to be between 1 in 100,000 and 1 in 6,000,000 manipulations. Given that Americans visit chiropractors more than 250,000,000 times per year and that 30 percent of these visits involve cervical manipulation, the incidence of arterial dissection is likely to be higher than the lowest estimates. A significant number of dissections may go unreported either because they are mild or asymptomatic.”
A safer way
Walls-Kaufman says the possibility of stroke caused by neck manipulation doesn’t cross his mind when patients come to see him because it is so rare. “I’ve never heard of one ,” he said. He employs what he says is a safer method of neck manipulation, one that involves twisting the head toward the shoulder in a way that does not challenge the artery. Alan Lichter, another Washington chiropractor, says he also uses a “more gentle” neck manipulation.
Although Lichter says that “more and more research shows that those who have strokes had a preexisting condition. . . . There may be some risk for people who are already at risk.”
Haran Caplan said she wishes she had been told beforehand that there was a risk, even very slight, in neck manipulation. She had gotten treatment many times before and doesn’t recall ever being given a consent form. Given her medical background, she says she never would have gone ahead with the treatment if she’d read that there was an even rare risk of a stroke. “I would have read it and left,” she said.
Beliveau, who had gone to the chiropractor due to lingering back pain from a car accident, said she also would not have done the treatment if she had known.
Keith Overland, president of the American Chiropractic Association, said through spokeswoman Melissa Lee that the group “supports informed consent and shared decision making with patients. . . . It is up to doctors to determine what they communicate to their patients based on a thorough health history and examination as well as consideration of local laws and legal standards.”
The parents of Jeremy Youngblood wish their son had understood the risk. A healthy 30-year-old, Youngblood went to a chiropractor in Oklahoma City in 2011 for neck manipulation seeking relief from lower back pain. It was his first visit. He died four days later. An autopsy report said he died of “acute cerebellar infarction due to manipulation of neck.”
Wade Smith, a neurologist and one of the authors of a 2003 study that found chiropractic manipulation to be an independent risk factor for stroke, said chiropractors need to warn people, even if the risk is small.
“If the practitioner does not want to discuss risks, then you shouldn’t go to that person,” Smith said.
Berger is a freelance journalist.
Gentle Chiropractic Techniques for Neck Pain
If the patient cannot relax, or simply dislikes the cavitation/cracking feeling or sound or any type of concerns, a gentle form of chiropractic adjustment may be utilized rather than the more traditional techniques. Some of these methods include a slower (low-velocity) technique performed within the passive range of joint motion.
- See Gentle Chiropractic Techniques
Common Gentle Chiropractic Techniques
Examples of commonly employed gentle chiropractic techniques include (but are not limited to):
- Cervical mobilization: The patient is usually lying on his or her back and is relaxed while the chiropractor manually moves the vertebra in the neck left to right, and vice versa, alternating between the side to side motion and a figure 8 movement, applied at varying degrees of moving the head forward, backward, and to the side and in rotation. This is a smooth, non-thrust type of stretch, with the goal of reducing fixations or areas where motion is restricted between the cervical spinal segments. An oscillatory movement with the hands is also frequently utilized during cervical spine mobilization.
- Cervical manual traction: The patient is usually lying face up or sitting, or less commonly prone (lying face down, on the stomach). The chiropractor gently pulls on the neck, stretching the cervical spine often varying the angle between flexion (forward) and extension (backward), based on comfort and searching for the correct angle to most efficiently reduce the tightness. This technique is often combined with mobilization, switching between the two and/or doing both simultaneously.
- See Manual Physical Therapy for Pain Relief
- Cervical “drop” techniques: The patient is either prone (lying on the stomach) or side lying on a special type of table where the head drop-piece is lifted into a “set” or locked position. The chiropractor then places his or her hand and/or finger over the spinal segment requiring the adjustment. A medium to high velocity, low amplitude thrust or, a non-thrust gradual increasing downward pressure is applied until the drop section / head piece of the table releases and drops a short distance. The goal is to reduce the fixation or restricted motion of the cervical vertebra assisted by the special table. There is usually no rotation or twisting of the head/neck often utilized in the traditional chiropractic adjustment and the typical “crack” (joint cavitation) may or may not occur with this method.
In This Article:
- Chiropractic Manipulation for the Cervical Spine
- Typical Cervical Problems Treated by Chiropractic
- Spinal Manipulation for Cervical Joint Dysfunction
- Gentle Chiropractic Techniques for Neck Pain
- Chiropractic Adjustment of the Cervical Spine (Neck) Video
Gentle Chiropractic Mobilization vs. Adjustment
Gentle chiropractic techniques typically do not involve rapid (high-velocity) rotation or side bending of the head and neck but rather a smooth, slow stretch (low-velocity, low amplitude).
There are several reasons a chiropractor may recommend gentle chiropractic techniques over a traditional high-velocity, low-amplitude adjustment, such as:
- Patient preference: Some patients do not feel comfortable with the traditional high-velocity thrust manipulation and prefer an approach that does not involve twisting their neck or joint “popping.”
- Provider experience: Some chiropractors may favor one technique over another or several types of techniques that they have gained experience and skills with. Most chiropractors utilize several approaches and often modify and adapt several techniques to the patient’s needs and preferences.
- Contraindications: Some patients may not be able to tolerate the traditional chiropractic adjustment sometimes based on past experience. In some cases where prior injury has resulted in certain types of spinal instability or, in cases of severe osteoporosis, cervical manipulation may not be appropriate. Other conditions include:
- In some cases of recent or acute trauma
- During the acute inflammatory phase of certain conditions, such as arthropathy, spondyloarthopathy
- When spinal instability is suspect, as is sometimes found in cases of Down’s Syndrome
- Over tumor or metastasis (cancer)
- Cauda equina-like syndrome (cervical cord compression)
- Spinal infections (such as osteomyelitis)
- Acute myelopathy
- Acute, unstable fractures
It is common for a combination of methods to be utilized, in addition to adjunctive therapy such as exercise and heat/cold therapies, for chiropractic management of cervical spine pain.
- See Neck Exercises for Neck Pain and Heat and Cold Therapy