Chiropractic Neck Adjustments Are Not Only Safe, But Vital for Our Physical Health

Published by Spine & Sport Center | Dr. Shane Conrad, DC

Are Chiropractic neck adjustments safe?

For decades, the persistent narrative in medicine has suggested that neck adjustments (or manipulations) carry a meaningful risk of stroke. These claims have been repeated so often that many patients remain confused by conflicting “opinions”.

It is long past time to address this question directly, and dismantle misinformed opinions with the scientific evidence. Why? Because the cervical spine is not just a stack of bones holding your head up. It is one of the most neurologically sophisticated structures in the human body, and maintaining its function is not a luxury. Chiropractic adjustments of the neck are the quickest way to SAFELY improve your neck function and address complaints including pain, headaches, and poor mobility.

The Stroke Controversy: What the Evidence Actually Says

The fear surrounding chiropractic neck adjustments causing stroke centers on a specific vascular event: vertebrobasilar artery (VBA) stroke. This is commonly associated with what is called a “vertebral artery dissection (VAD)” — a tear in the inner lining of one of the vertebral arteries that supply the brainstem and cerebellum. The concern is that a high-velocity cervical manipulation (you might call it ‘neck cracking’) damages the vertebral artery, triggering a dissection and subsequent stroke.

Sounds plausible. I mean it looks scary on those YouTube videos. And if commando movies taught me anything, it's that a quick twist of the neck is the easiest way to kill an unsuspecting bad guy! Unknown to many people (and most Medical Doctors), VBA Stroke has been scientifically investigated numerous times. The results are consistent: Chiropractic neck adjustments DO NOT cause VBA stroke.

The Cassidy Studies: The Definitive Evidence

The most frequently cited study is the 2008 investigation by Dr. J. David Cassidy and colleagues, published in the highly respected journal Spine. Cassidy analyzed over a decade of health data drawn from Canadian hospital records in the province of Ontario (April 1993 to March 2002).

The study examined every incident of VBA stroke admitted to Ontario hospitals during that period. They explored whether patients had visited a Chiropractor or a primary care physician (PCP) in the days before their stroke. The findings were as follows:

"VBA stroke is a rare event in the population. The increased risks of VBA stroke associated with Chiropractic and PCP visits is not greater than the increased risks associated with PCP visits alone." — Cassidy et al., 2008

In other words, patients who suffered a VBA stroke were no more likely to have visited a Chiropractor than to have visited a medical doctor. The association between Chiropractic visits and VBA stroke was statistically identical to the association between primary care physician visits and VBA stroke.

The explanation was as follows:

People in the early stages of a VBA Stroke experience neck pain and headache as the most common first symptom. Some seek care from a Chiropractor for their symptoms; some visit their MD. In neither case is the provider causing the stroke.

This was simply a convenient narrative for the medical community to criticize a competitor to the allopathic medical model. Chiropractors are the leading profession in what has been referred to as “Alternative Healthcare”. The medical establishment has long been eager to paint alternative medicine as unscientific. The medical establishment used fear to label Chiropractors as quacks or witchdoctors operating outside of the boundaries of “scientific” medicine. A label I’ve personally fought against every day in my 25-year career.

Vertebral Artery Dissection Happens Spontaneously — Without Any Chiropractic Involvement

Vertebral artery dissection is not a unique event caused by Chiropractic care. It occurs from a wide range of ordinary daily activities involving cervical movement, including:

• Sustained neck extension while painting a ceiling
• Vigorous nose-blowing
• Yoga postures involving cervical hyperextension
• Sneezing
• Coughing
• Hair washing at a salon sink
• Sleeping in an awkward position
• Sports and recreational activities

The vertebral artery in some individuals is predisposed to injury. Spontaneous dissection is an infrequent event for healthy individuals, but it does occur. And in many cases the cause is never identified. The premise that Chiropractic neck manipulation uniquely endangers the vertebral artery is not supported by the literature.

The Rate of Serious Adverse Events Is Vanishingly Small

When serious adverse events following cervical manipulation have been systematically examined, the numbers are extraordinarily low. A 2022 systematic review published in PMC examining cervical spine manipulations from a rehabilitation medicine perspective confirmed that most adverse events following cervical manipulation are mild and transient and that serious adverse events are incredibly rare.

To contextualize this: non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are associated with gastrointestinal bleeding or ulceration. The American Journal of Gastroenterology has estimated that NSAID-related gastrointestinal complications result in over 100,000 hospitalizations and 16,500 deaths annually in the United States alone. The safety profile of Chiropractic neck manipulation is comparatively better than taking ibuprofen.

The Medical Literature Supports Chiropractic Safety

Subsequent to the Cassidy study, multiple systematic reviews and population-level studies have reinforced these conclusions.

In 2016, Cassidy and colleagues published a direct follow-up to their landmark 2008 study, this time examining carotid artery stroke. The conclusion was identical to the 2008 findings: no excess risk of carotid artery stroke was observed after Chiropractic care. The 2008 study silenced the vertebrobasilar stroke argument. The 2016 study silenced the carotid stroke argument. Taken together, they provide strong evidence against the association of Chiropractic neck adjustments and stroke.

Beyond Safety: Why the Cervical Spine Needs Chiropractic.

The cervical spine is not simply a mechanical structure. It is one of the most neurologically active regions in the entire human body. What happens in the cervical spine ripples outward into balance, vision, coordination, cognitive function, and the body's capacity to orient itself in space.

The Cervical Spine: The “Sixth Sense” Of The Body

Sensory receptors within muscle tissue exist that encode position and velocity of movement. We call these receptors Muscle Spindles. — are distributed throughout the body, but they are not distributed equally. Neck muscles have among the highest density of muscle spindles of any muscle group in the human body. These muscles convey precise information to the brain during movement. The muscles of the neck are so important in movement and motor coordination that they could be called a sixth sense. Disruption of the cervical spine (particularly the joints and muscles) can lead to sensory impairment and movement dysfunction. Posture, balance, and visual tracking can also be affected.

Sensation from the neck converges in the brainstem alongside balance and vision to produce a unified, coherent picture of where the head and body are in space. When those signals are distorted, problems arise.

The Cervicogenic Vestibular Connection: Balance and Dizziness

The brainstem receives proprioceptive input from the cervical spine and integrates it with signals from the vestibular apparatus (the inner ear organs that detect linear and rotational acceleration) and the visual system. This three-way integration — cervical, vestibular, visual — is the foundation of postural stability and spatial orientation.

Research by Dr. Julia Treleaven at the University of Queensland has been seminal in documenting what happens when cervical dysfunction disrupts this integration. Her work, including a foundational 2009 review published in the Journal of Orthopaedic and Sports Physical Therapy, established that patients with neck pain demonstrate measurable deficits in:

• Cervical spine repositioning.
• Balance and postural stability.
• Visual tracking and stability.
• Automatic eye movements.

Disrupted cervical proprioception conflicts with vestibular and visual systems resulting in dizziness, unsteadiness, and impaired spatial orientation. This is the natural consequence of a dysfunctional cervical spine.

The Oculomotor System: Your Eyes Are Driven by Your Neck

Perhaps the most underappreciated dimension of cervical spine neurology is its relationship to vision. Cervico-ocular reflexes (a reflex arc that produces automatic eye movements in response to cervical movement) are impaired in patients with cervical dysfunction. The eyes are impaired because their neck is impaired. This results in blurred vision, visual fatigue, dizziness, and difficulty tracking objects. Chiropractic adjustments to the neck help restore the connection from the neck to the brain and alleviate these symptoms. It's not always about pain!

Cervical Adjustment and the Brain: Measurable Cortical Changes

Dr. Heidi Haavik and Dr. Bernadette Murphy at the New Zealand College of Chiropractic have produced some of the most compelling neurophysiological evidence for the effects of cervical Chiropractic adjustments on the brain. Their work has demonstrated that a single Chiropractic neck adjustment produces measurable changes in brain activity. For the nerds reading this, the N20 and N30 cortical peaks increase following a Chiropractic neck adjustment, which is objective evidence that the brain is processing proprioceptive information better.

Their 2012 study published in the Journal of Electromyography and Kinesiology showed that spinal manipulation of dysfunctional cervical joints alters sensory integration during voluntary movements. A follow-up study demonstrated that cervical adjustment improved upper limb joint position sense. The brain is receiving better information after the adjustment, and movement control improves as a result.

This is not a minor finding. It is evidence that chiropractic adjustment of the cervical spine is a neurological intervention that modifies brain function in clinically meaningful ways. Chiropractic adjustments improve mobility of the joints AND the functional coordination of movement that occurs around those joints!

Cervicogenic Headache and Neck Pain: The Clinical Evidence

Beyond the neurological arguments, the evidence for the clinical effectiveness of Chiropractic neck manipulation in the management of neck pain and headaches is substantial.

A 2017 Cochrane review on manual therapy for neck pain confirmed that spinal manipulation and mobilization produce clinically meaningful reductions in neck pain and disability compared to inactive controls. A 2021 review published in Frontiers in Pain Research examining the clinical effectiveness of chiropractic spinal manipulative therapy across spinal pain conditions found consistent evidence supporting cervical manipulation as an effective intervention for both acute and chronic neck pain.

For cervicogenic headaches, the evidence for manipulation is particularly strong. Research by Dr. Gwendolen Jull and colleagues at the University of Queensland demonstrated that a combination of cervical manipulation and neck exercises produced greater headache reduction than either treatment when provided alone.

The Cost of Cervical Dysfunction

While pain and stiffness are often the biggest complaint I see in my office, it's worth noting that the neurological consequences of these complaints run deeper. Degraded cervical proprioception impairs balance and increases fall risk. Disrupted cervicogenic vestibular integration can produce dizziness and spatial disorientation. Impaired oculomotor coordination produces visual disturbances and cognitive fatigue. Altered motor control in the neck muscles contributes to headache, temporomandibular dysfunction, and referred symptoms into the arm. Left untreated, these “painless” symptoms can lead to persistent dysfunction that results in pain that is more difficult to treat. And prolonged exposure to noxious sensations (pain, stiffness, tightness) can then lead to central sensitization that amplifies the symptoms across the entire body. The end result is a localized injury creating collateral damage in related and unrelated regions of the body.

The Spine & Sport Center Approach to Cervical Care

At Spine & Sport Center, we approach the cervical spine with an evidence-based mindset. You can be confident that your treatment will be safe, effective, and produce the results you’re looking for.

Your assessment begins with a thorough history and clinical examination designed to identify the source of your symptoms. When cervical manipulation is performed, it is precise and delivered with clinical intent. Appropriate force is applied to the dysfunctional joint(s) and combined with therapies selected to complement and enhance the adjustment. Chiropractic adjustments are a neurological intervention delivered with the understanding of the cervical spine's essential role in sensorimotor integration, proprioception, and postural control.

The Bottom Line

The evidence on Chiropractic neck adjustments is clear and objectively established:

The stroke risk is not attributable to Chiropractic care. Vertebral artery strokes occur spontaneously. The common precursor to a stroke in progress is neck pain that motivates patients to seek care. In the established research, Chiropractic visits carried identical risk to primary care physician visits, indicating that the adjustment does not cause the stroke.

The neurological importance of the cervical spine is well documented. The cervical spine is the center of the body’s “Sixth sense”: a proprioceptively rich region that is fundamental for balance, oculomotor control, and as a major source of sensory input to the brain. Therefore, its optimal function is of great importance.

The evidence clearly shows that Chiropractic neck adjustments restore joint mechanoreceptor function, improve proprioceptive accuracy, reduce pain, and produce measurable neurological changes at the brain level. As such, Chiropractic neck adjustments should form the foundation for the non-surgical care of orthopedic neck injuries and pain syndromes.

Scientific References

1. Cassidy JD, Boyle E, Côté P, et al. "Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study." Spine. 2008; 33(4 Suppl):S176-183.
2. Cassidy JD, Boyle E, Côté P, Hogg-Johnson S, Bondy SJ, Haldeman S. "Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study." Journal of Stroke and Cerebrovascular Diseases. 2017; 26(1):35-40. PubMed ID: 27884458.
3. Treleaven J. "Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control." Manual Therapy. 2008; 13(1):2-11.
4. Treleaven J. "Sensorimotor Function and Dizziness in Neck Pain: Implications for Assessment and Management." Journal of Orthopaedic & Sports Physical Therapy. 2009; 39(5):364-377.
5. Treleaven J. "Dizziness, Unsteadiness, Visual Disturbances, and Sensorimotor Control in Traumatic Neck Pain." Journal of Orthopaedic & Sports Physical Therapy. 2017; 47(7):492-502.
6. Haavik H, Murphy B. "Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense." Journal of Manipulative and Physiological Therapeutics. 2011; 34(2):88-97.
7. Haavik H, Murphy B. "The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control." Journal of Electromyography and Kinesiology. 2012; 22(5):768-776.
8. Haavik H, Murphy B. "Cervical spine manipulation alters sensorimotor integration: A somatosensory evoked potential study." Clinical Neurophysiology. 2007; 118(2):391-402.
9. Haavik H, Murphy B. "Manipulation of dysfunctional spinal joints affects sensorimotor integration in the prefrontal cortex." Neural Plasticity. 2016.
10. Jull G, Trott P, Potter H, et al. "A Randomized Controlled Trial of Exercise and Manipulative Therapy for Cervicogenic Headache." Spine. 2002; 27(17):1835-1843.
11. Pickar JG. "Neurophysiological effects of spinal manipulation." Spine Journal. 2002; 2(5):357-371.
12. Frontiers in Neurology. "Dizziness and neck pain: a perspective on cervicogenic dizziness exploring pathophysiology, diagnostic challenges, and therapeutic implications." 2025. https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1545241/full
13. Musculoskeletal Science & Practice. "Clinical recognition of the role of the cervical spine in signs and symptoms of altered sensorimotor control." 2024. https://www.mskscienceandpractice.com/article/S2468-7812(24)00282-0/fulltext
14. Frontiers in Pain Research. "Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain." 2021. https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2021.765921/full
15. PLOS ONE. "The Quality of Reports on Cervical Arterial Dissection following Cervical Spinal Manipulation." 2013. https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0059170
16. PMC. "Cervical Spine Manipulations: Role of Diagnostic Procedures, Effectiveness, and Safety from a Rehabilitation and Forensic Medicine Perspective." 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9139983/
17. Gross A, et al. "Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment." Cochrane Database of Systematic Reviews. 2015.
18. Kosloff TM, Elton D, Tao J, Bannister WM. "Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations." Chiropractic & Manual Therapies. 2015; 23:19.
19. Whedon JM, et al. "Association Between Utilization of Chiropractic Services for Treatment of Neck Pain and the Risk of Vertebrobasilar Stroke." Journal of Manipulative and Physiological Therapeutics. 2015.
20. Richmond FJ, et al. "Muscle-spindle distribution, morphology, and density in longus colli and semispinalis cervicis muscles of the cat." Journal of Neurophysiology. 1999.