Expert: Scott F. Gillman, DC, DACBSP - 1/27/2007

Question
I am aware that there are potential serious complications from chiropractic neck manipulations.  However, I find them helpful (albeit temporary) and would like to continue them.  What signs/symptoms should I be aware of that indicate I should no longer receive neck manipulations or that I should seek immediate medical care?

Answer
Jane,

If you have significant dizziness, nausea, and disabling headache following neck joint manipulation, that would be a good reason for concern.  If you don't have any problems with neck joint manipulation so far, odds are that you never will.  While it is not uncommon to experience soreness or headaches on occasion following manipulation, these are often transient and benign, as well as preventable (talk to your DC about massaging or using heat packs post treatment).  Otherwise, the one-in-a-million to one-in-40-million odds of a serious complication pales in comparison to the odds of serious complication to a many common pharmacologic or surgical procedures.  If your chiropractor is clinically competent, then in the event of potentially serous side effects you would be quickly assessed and emergency care provided if needed.  Jane, biased journalism, has made a bigger deal out of chiropractic neck joint manipulation than need be. This is also fostered by medical authors with a clearly biased agenda.  While the chiropractic profession is very aware of the potentially devastating consequences of neck joint manipulation, we are also best aware of which patients to be careful treating, what signs and symptoms to look for in the event something goes wrong.  There have been cases were a patient presents with neck pain and headaches, got their neck adjusted (and even felt better), then had a cerebrovascular event (e.g. stroke) soon after, sometimes hours after.  One theory is that the patient's pain came from a slowly leaking artery in the neck due to a damaged vessel wall, and the neck manipulation tears the artery further.  There have been cases of abrupt, cerebrovascular accident on the treatment table, with some patient not surviving.  This is extremely rare!  Please remember to put this in perspective with the frequency of patients dying from their prescription medicines, about 300,000 per year.   Also, to put things in perspective, the liability insurance plan for a chiropractor is about 1/10th the cost of our medical counterparts.  One of our harshest critics, Ernst, wrote recently in a journal commentary on the "Life Threatening Complications following Joint Manipulation."  He stated: "Five such investigations (large-scale studies)have been published, and none reports a single case of a serious omplication.17 This apparently confirms the assumption that complications are extreme rarities. Vis a vis the many thousand manipulations carried out daily, 200 or 300 complications in 5 years could be almost negligible."

Jane, I know this was a bit of information to answer your simple question, but I hope you found it helpful.  

Dr. G