Neck Physical Therapy: Stroke Risk And Prevention

Neck cracking, also known as neck popping or cervical spinal manipulative therapy, is a common practice used to treat neck pain. While it may provide temporary relief, it can also cause a stroke in rare cases. This happens when a tear or injury occurs in the blood vessel walls in the neck, leading to a blockage in blood flow to the brain. This blockage can cause severe consequences, including paralysis and even death.

The risk of a stroke occurring from neck manipulation is a topic of debate, with some arguing that the benefits of neck manipulation outweigh the potential health risks. However, it is important to note that neck cracking may be especially dangerous for people with fragile and weak connective tissues due to genetic inheritance.

To reduce the risk of a stroke, it is recommended to avoid excessive or forceful neck manipulation and to seek professional care if any discomfort is felt after neck cracking.

Can neck cracking cause a stroke?

Neck cracking, or neck manipulation, is a common practice often performed by chiropractors, massage therapists, osteopaths, and even at home to relieve neck pain. While it is a popular form of treatment, there have been concerns about its safety, particularly the risk of stroke following this procedure. So, can neck cracking cause a stroke?

In rare cases, neck cracking has been found to cause strokes due to a condition called cervical artery dissection, more commonly known as vertebral artery dissection. This occurs when an artery in the neck tears, leading to blood leaking into the wall of the blood vessel and eventually forming a blood clot. The clot can block the artery, reducing or cutting off blood flow to the brain, resulting in a stroke.

The risk of neck cracking causing a stroke is considered very low, and such cases are rare. However, it is important to be aware of the potential risks associated with neck manipulation. Some people may be more prone to experiencing a stroke due to underlying conditions such as atherosclerosis, fibromuscular dysplasia, or genetic disorders affecting connective tissue.

To minimize the risk of stroke, it is recommended to seek treatment from a licensed and trained healthcare professional, such as a chiropractor or osteopath, who can properly assess the benefits and risks for each individual case. Additionally, obtaining medical clearance before undergoing neck manipulation can help identify potential risk factors and reduce the likelihood of adverse events.

While the benefits of neck manipulation in treating neck pain may outweigh the risks for most people, it is crucial to be informed about the potential dangers and take necessary precautions to ensure safety.

What is cervical artery dissection?

Cervical artery dissection is a tear in a carotid or vertebral artery, which are the blood vessels in your neck that provide oxygen-rich blood to your brain. This tear makes it possible for blood clots to form, which can lead to a stroke. Cervical artery dissection is a common cause of stroke in young and middle-aged adults, accounting for around 2% of ischemic strokes overall, and is particularly common in people under 50.

Cervical artery dissection can occur due to injury to the head or neck, such as from a car accident or whiplash, or from non-traumatic causes such as straining, heavy lifting, vomiting, or persistent coughing. It has also been linked to certain genetic conditions that affect connective tissue, like Ehlers-Danlos syndrome and Marfan syndrome, as well as problems with blood vessels, such as fibromuscular dysplasia.

Symptoms of cervical artery dissection can be vague and vary from person to person. They depend on the severity of the artery damage and whether a stroke occurs afterward. They can include severe and sudden head or neck pain, stroke-like symptoms, and Horner's syndrome, which affects the involuntary function of the eyes and face.

Diagnosis of cervical artery dissection is typically done through a CT angiography or magnetic resonance angiography, which take detailed images of the blood vessels, or an ultrasound scan, which uses sound waves to produce an image of the blood vessels. Treatment often involves medications to prevent blood clots, such as antiplatelet therapy or anticoagulant medications, and sometimes procedures like stenting are necessary to reinforce and expand blood vessel walls.

What are the signs of a stroke after neck cracking?

While neck cracking or manipulation can lead to a stroke in rare cases, it is important to be aware of the signs and symptoms of a stroke, especially if you have a history of neck cracking or have recently undergone neck manipulation. Here are some signs and symptoms to watch out for:

• Numbness or weakness, especially if it affects one side of the body or face.
• Dizziness or loss of balance.
• Problems with vision, such as blurred vision or loss of vision in one eye.
• Slurred speech or difficulty speaking or understanding speech.
• Paralysis or difficulty lifting limbs, including numbness or weakness in movement.
• A severe headache, which may be an early symptom of a stroke.
• Neck pain, which can be an early symptom of a stroke.

If you or someone around you experiences any of these symptoms after neck cracking or manipulation, it is crucial to call emergency services immediately. While neck cracking may seem harmless, it can lead to a rare type of stroke called vertebral artery dissection or cervical artery dissection. This occurs when an artery in the neck tears, causing blood to leak into the wall of the blood vessel and potentially forming a blood clot that blocks blood flow to the brain.

What are the alternatives to relieve neck tension?

There are several alternatives to relieve neck tension, including stretches, hot and cold therapy, over-the-counter medications, and lifestyle changes.

Stretches

Stretching can help relieve pain and stiffness and prevent it from recurring. It is important to stretch gently and slowly, making sure to breathe in and out fully. Sudden movements or over-stretching can cause more pain or injury.

Some examples of stretches that can help with neck tension include:

• Neck circles
• Shoulder rolls
• Upper trapezius stretch
• Thread the needle
• Overhead side reach
• Cat-cow pose
• Thoracic extension
• Wall angels
• Seated clasp neck stretch

Hot and Cold Therapy

Using ice packs or heating pads can help relieve neck pain fast. Ice reduces inflammation, while heat relaxes stiff neck muscles. For best results, you may alternate between the two for about 20 minutes each, several times a day.

Over-the-Counter Medications

Minor neck strains may get better after a day or so of over-the-counter pain-relieving medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen help reduce inflammation and decrease discomfort. Acetaminophen and naproxen are other over-the-counter medicines that can effectively relieve neck pain.

Lifestyle Changes

Lifestyle changes, such as improving your posture, losing weight, exercising regularly, quitting smoking, and managing stress can also help relieve and prevent neck tension.

What are the risks of professional neck manipulation?

Chiropractic cervical manipulation is a common practice used worldwide. However, most patients are never cleared medically for manipulation, which can be devastating for those few who are at increased risk for dissections. The high-velocity thrust used in cervical manipulation can produce significant strain on carotid and vertebral vessels. Once a dissection has occurred, the risk of thrombus formation, ischemic stroke, paralysis, and even death is drastically increased.

The stroke itself occurs due to a condition called cervical artery dissection, which is more commonly referred to as vertebral artery dissection. This is when an artery in your neck tears, causing blood to leak into the wall of the torn blood vessel, between the thin layers that make up the blood vessel wall. As blood leaks, the space inside the blood vessel through which blood normally flows becomes narrow or even completely blocked. Eventually, the blood from the torn artery can clot, blocking the artery and reducing or cutting off blood flow to an area of the brain. The regions of the brain normally supplied by the damaged blood vessels can experience diminished blood flow, resulting in a stroke.

Strokes due to vertebral artery dissection are rare, accounting for only 2% of ischemic strokes overall, but they are a notable cause of stroke in younger people. They can also cause paralysis. In some cases, the early symptoms can be subtle and may include neck pain and a headache.

There has been debate over neck manipulation and whether it should be used to treat neck pain. The National Center for Complementary and Integrative Health says spinal manipulation by a properly trained and licensed professional is relatively safe. However, the center notes that people who opt for neck manipulation should be aware of the associated risks.

If you seek chiropractic care for neck pain, use a licensed chiropractor who will work collaboratively with you and a primary care doctor. Try to find a chiropractor who has experience addressing neck pain.

Frequently asked questions