Expert: Gerald Anzalone, D.C. - 1/30/2007

Question
I recently had a neck adjustment.  For the last four days since, I have had a headache, some dizziness, nausea, and neck pain, I have had neck adjustments before and not had these symptoms, what should I do? should I discontinue neck manipulations, are there other chiropractic options for chronic neck pain and stiffness or will I just have to go on medications? (which I prefer to avoid.)

Answer
Jane,

Thank you for your question, which touches on a sensitive  but practical issue within the chiropractic professional community.

A 2005 randomized trial published in the medical journal Spine found that of 280 participants, 85 had 212 adverse symptoms as a result of chiropractic care. Increased neck pain or stiffness was the most common symptom, reported by 25 of the participants. Less common were headache and radiating pain. Patients who received manipulation were more likely than those who received mobilization to have an adverse symptom occurring within 24 hours of treatment (reference: Hurwitz E, Morgenstern H, Vassilaki M et al. Frequency and Clinical Predictors of Adverse Reactions to Chiropractic Care in the UCLA Neck Pain Study.)

This study suggested that adverse reactions to chiropractic care for neck pain are common and that despite somewhat imprecise estimation, adverse reactions appear more likely to follow cervical spine manipulation than mobilization. The authors concluded that given the possible higher risk of adverse reactions and lack of demonstrated effectiveness of manipulation over mobilization, chiropractors should consider a conservative approach for applying manipulation to their patients, especially those with severe neck pain.

Any therapeutic intervention carries the risk of producing undesirable results. Therefore, the competent and skilled practitioner decides upon a particular therapeutic course of action after considering the risk/benefit outcome in the light of the patient's clinical scenario.

While in some cases neck soreness may result from a thrusting manipulation, I am more concerned about the dizziness and nausea that you have developed following neck adjustments/manipulation. As I am not familiar with your medical history, your clinical scenario, and any medications that you may be taking, it is critical that you notify your chiropractor of these symptoms, especially since you have had prior neck manipulations without complications. In my opinion, further thrusting manipulations are not advisable, and I would recommend an evaluation with a neurologist if your symptoms are persistent.

In my opinion, a safe option to thrust manipulations would be mobilization techniques, as stated in the research study referenced above. Chiropractors are trained to employ a variety of joint mobilization and soft tissue techniques as an alternative or an adjunctive therapeutic approach to joint manipulation. However, additional clinical evaluation may be necessary in your case to rule out an underlying medical concern before further manual therapy procedures are implemented.

I hope that this adequately answers your question.