‎Is it safe to manipulate your neck with a chiropractor?‎

‎Most joint manipulations aren’t dangerous, but a rare complication can result in serious injury.‎

‎Going to chiropractor has become an accepted part of medical care, with about 15% of adults in the United States visiting one each year. Although critics claim that the field lacks scientific validity, chiropractic treatment provides pain relief to many, and mostly without accident.‎

‎But given the delicate nature of the spine — especially the upper spine of the neck — the consequences of complications can be devastating. In particular, an injury, a rupture of the arteries, in which the blood vessels supplying blood from the heart to the brain burst, is a matter of great concern. In some cases, the patient may be unaware that the injury has occurred and the damage heals automatically. In others, a tear in the arterial wall can cause a clot to form and result in paralysis and even death.‎

‎It’s unclear how common this complication is after chiropractic care — one in an estimated 1,000 neck manipulations has arterial rupture, says another in 5.8 million (three of the four authors of this study worked for chiropractic associations).‎

‎Because of the severity of the injury, though, many spinal experts have warned that caropractic manipulation of the neck can be dangerous. Here’s what to know if you’re considering treating your neck pain.‎

‎Risks of neck manipulation‎

‎Chiropractic manipulation involves rapid, low-amplitude movements of the spinal cord. “We take the joint to its limited range and we push the joint very quickly,” said William Laretti, professor of integrated chiropractic therapies at the North East College of Health Sciences and a spokesman for the American Chiropractic Association. “But we’re moving it to a very, very small range – it’s a lower dimension.”‎

‎Concern over arterial tears is specific to neck manipulation. This is partly because the neck is more active and thus more prone to injury. The torso is protected from the ribs, so the lower part of the waist doesn’t rotate as much. The large arteries dividing blood from the heart to the brain are also tied through the spines of the neck, which makes the blood vessels there more weak.‎

‎”When you bend your neck from one side to the other, these vessels move inside the bone,” says Dr Betsy Grinch, a neurosurgeon at Gainesville.‎

‎The most common symptoms of arterial rupture are headaches, dizziness and vertigo. On the one hand, there may be weakness, apathy or paralysis.‎

‎Last year, Caitlin Jensen, a 28-year-old graduate student at Georgia Southern University, felt dizzy when a chiropractor manipulated her neck, making her dizzy and nauseous. Chiropractor called 911, and doctors at the hospital found that Ms. Jensen had tears in four blood vessels, resulting in paralysis and a heart attack.‎

‎Nine months later, Miss Jensen has just started speaking again, though she still can’t walk or swallow. The injury paralyzed the right side of his body, as were the strings of his voice. Her mother, Darlene Jensen, told the New York Times that her daughter’s recovery was progressing, but it was slow. “It’s very encouraging when we have really good days and good therapy sessions,” darlene Jensen said. But then on other days, when she is struggling with something, it is very frustrating and emotional because she just wants her life back.‎

‎Edzard Ernst, emeritus professor of complementary medicine at The University of Exeter in the UK, wrote in an email that it is almost impossible to know how common cases like Caitlin Jensen are, because “there is no monitoring system to record such events.” “Many patients sue Cheru and walk out of court. Many patients have paralysis and can never link it to manipulation. (Darlene Jensen said the insurance company for the caropractor paid the misconduct claim without disagreeing.)‎

‎A study of more than 50,000 spinal manipulations found that 16 out of 1 people cause fainting, dizziness and mild head loss. Other researchers have tried to estimate the risk by working backwards: finding people who had experienced arterial rupture and determining whether their necks had recently been manipulated by chiropractors. For example, one small study found that 000% of arterial rupture occurred after sports activity, and <>% followed chiropractic manipulation.‎

‎According to a review by the Stroke Council of the American Heart Association, several studies have shown that people who have recently manipulated the neck are three to 12 times more likely to have arterial rupture and stroke.‎

‎For Dr. Grunch, who treats one or two patients with an injury each year, the connection is clear: “Arterial rupture is a well-known complication of spinal manipulation.”‎

‎Dr Alan Hillibrand, head of spine surgery at the Rothman Orthopaedic Institute in Philadelphia and former president of the Cervical Spine Research Society, says there is “no smoking gun” in the scientific literature. However, he added, “I am very upset with this”, and he warned patients that neck manipulation can be dangerous.‎

‎Are chiropractors being unfairly blamed?‎

‎Many chiropractors dispute the claim that their treatments can cause such significant harm. They pointed to reviewing papers that found no link between neck ligaments and arterial tears, and research showed that people who went to a primary care doctor had the same risk of stroke in the weeks following the appointment as those who saw chiropractor.‎

‎Instead, they say, a chiropractor visit is often the result of arterial rupture, not the cause.‎

‎”These patients have an artery that has been injured in some way, which causes neck pain and headaches,” Dr Loretti said. “Some of them go to their primary care doctor, some of them go to their chiropractor. If the patient has paralysis after a chiropractor attack, the chiropractor is to blame.‎

‎Dr. Loretti added that when a patient goes to the chiropractor for neck pain, the doctor should do a thorough check to rule out any “red flags” before manipulating the neck.‎

‎Recognizing neck weakness, some chiropractors take a more conservative approach when treating the area. Philip Cordova, a Houston chiropractor, said in his office he doesn’t rotate the neck too far in an attempt to minimize the chances of injury. Dr Cordova said some patients even tell her that “I don’t want to adjust my neck” and that’s not a problem. “We work around it. ”‎

‎The risk of complications from chiropractic treatment of other parts of the spinal cord is extremely low, and some research suggests that this exercise is as beneficial as home exercise, physical therapy, and medication. As a result, many orthopedic surgeons and neurosurgeons — including Dr. Grunch and Dr. Healeybrand — sometimes refer patients to chiropractors for problems that are not related to the neck.‎

‎”I think it’s entirely appropriate to include chiropractic treatment as part of a conservative treatment plan,” Dr. Grunch said.‎

‎Dr. Hailey Brand agreed. “I will not hesitate to send a patient to someone I know. “Many of them provide very good care.‎

‎So what should you do about neck pain?‎

‎Accidents caused by chiropractic manipulations are very uncommon, but because of their potential severity, it may be better to avoid treatment if you’re experiencing neck pain. Fortunately, there are many other options available.‎

‎Dr. Healy Brand suggests that the first line of treatment is over-the-counter pain medications combined with physical therapy. He said that 80 percent of people with neck pain will get better after six weeks before these two interventions alone.‎

‎If the pain persists, Dr. Hellebrand said you might want to consider alternative treatments, such as acupuncture or massage techniques called myofascial release. You can even visit the chiropractor for soft manual therapy or traction, which involves less aggressive, more controlled stretches or movements. (Although in cases of spinal pressure, he said people should stay away from chiropractors altogether.) Steroid injections may also be helpful in reducing pain and inflammation.‎

‎In some cases, surgery may be needed as a last resort, but experts say nonsurgical treatments can often solve the problem. “Most patients with severe neck or back pain don’t need surgery. “They just need a good, well-balanced conservative treatment plan.”‎