Neck Adjustments: What to Expect and Safety Questions

Your neck is stiff, and a friend swears by their chiropractor. But you've also read a headline about neck adjustments and strokes. Now you're not sure what to believe. That's a fair question, and you deserve a straight answer before anyone touches your neck. Here's what happens, what the research says, and what to do if you'd rather skip an adjustment. For the causes of a stiff neck itself, see our neck pain guide.

What happens during a neck adjustment?

A neck adjustment is a quick, controlled movement of one joint in your neck, done by hand. It usually takes a few seconds. It comes after your doctor has listened to your story and examined you.

At your first visit, your doctor asks about your pain, your health history, and any recent injuries. They check how your neck moves and test the strength, reflexes, and feeling in your arms. X-rays are taken only when your exam calls for them. Treatment begins at your second visit, or the same day in acute cases if your doctor decides it's appropriate.

During the adjustment itself, you usually lie on your back or sit up. Your doctor gently holds your head and guides your neck to the end of its comfortable range. Then they apply a short, precise push to one joint. You may hear a pop. That sound is usually gas releasing from the joint, not bones moving out of place. Learn more about how a chiropractic adjustment works and whether neck cracking at home is a concern.

Your doctor should tell you what they plan to do before they do it. You can say no, ask questions, or stop at any point.

What are the common side effects of a neck adjustment?

Short-lived soreness is the most common side effect. Some people also notice stiffness, a mild headache, or tiredness. These usually fade within a day.

The National Center for Complementary and Integrative Health (NCCIH) points to a 2017 review of 250 publications². It found that mild to moderate side effects often occur. These included temporary pain, stiffness, or headache. They usually went away within 24 hours. According to Mayo Clinic¹, some people have minor side effects for a few days, such as headache, soreness in the treated area, or fatigue.

Think of it like the soreness after a new workout. It's a sign your neck was moved in a new way, not a sign of harm. Tell your doctor at your next visit, and they can adjust your plan. See what's normal if you're sore after a chiropractic adjustment.

Can a neck adjustment cause a stroke?

This is the question most people really want answered. The honest answer: a link has been reported, it's very rare, and research hasn't shown that the adjustment is the cause.

The concern is a cervical artery dissection. That's a small tear in the wall of an artery in your neck. A blood clot can form at the tear and lead to a stroke. According to Cleveland Clinic⁵, it's a common cause of stroke in people ages 40 to 60. Its most common cause is injury, such as a car accident. Rapid head movements, heavy lifting, straining, and long bouts of coughing are also listed.

What the research shows

According to NCCIH², neck manipulation has been linked to these artery tears. Such strokes are very rare, and there are no accurate estimates of how often they happen. NCCIH also notes that experts disagree on whether manipulation can actually cause a tear.

A large Ontario study looked at 818 people hospitalized with this type of stroke³. Among people under 45, those who had a stroke were about three times as likely to have seen a chiropractor beforehand. They were also about three times as likely to have seen a family doctor. Among people over 45, chiropractic visits showed no link to stroke.

The researchers' explanation is important. A tear that's already forming often causes neck pain and headache first. Those symptoms send people to a chiropractor or a family doctor before the stroke happens³. The study found no evidence of extra stroke risk from chiropractic care compared with primary care.

In 2014, the American Heart Association and American Stroke Association reviewed the evidence⁴. They said neck manipulation may be associated with these tears. They also said it can't be said with certainty that it causes them. They advised that patients be told about this association before a neck adjustment. We agree, and that's why we're telling you here.

[Quote from the reviewing doctor on how they talk through neck adjustment risks and options with new patients — drafted with them.]

Who should avoid a neck adjustment?

A neck adjustment isn't right for everyone. Your exam and health history help your doctor decide whether it's a good fit.

According to Mayo Clinic¹, you shouldn't have a chiropractic adjustment if you have:

• Severe osteoporosis
• Numbness, tingling, or loss of strength in an arm or leg
• Cancer in your spine
• An increased risk of stroke
• A problem with how a bone in your upper neck is formed

Also tell your doctor about any recent neck injury, including a car crash or a hard fall⁴. Mention a new headache or neck pain that feels different from anything you've had before. Share any connective tissue condition, such as Ehlers-Danlos syndrome, and any blood vessel problems⁵. These details change what your doctor recommends. If you have thinning bones, see whether chiropractic is safe with osteoporosis.

What are the warning signs of a stroke or artery tear?

According to the CDC⁶, call 911 right away and note when symptoms started. Don't drive yourself to the hospital. Ambulance staff can start care on the way.

Not every neck pain needs the emergency room. Learn when neck pain is serious and when it can wait for a regular visit.

What if I don't want my neck adjusted?

Then your doctor won't adjust it. You choose your care, and there are other good options. Many patients start with gentler care and decide later.

Care guidelines for recent neck pain support a mix of exercise with either adjustments or gentle joint movement⁷. That means a quick adjustment isn't the only hands-on choice. Options your doctor may talk through include:

• Gentle joint movement. Slow, controlled movements loosen a stiff neck without a quick push.
• Gentle muscle work. Hands-on work for tight muscles in your neck, shoulders, and upper back.
• Exercise. Guided movements to build strength and range of motion, plus moves to do at home.
• Daily habit changes. Tips for your screen height, your car, and your pillow.

See more about gentle chiropractic options if you'd rather not have an adjustment.

Good questions to ask your doctor

• What did you find in my exam, and why do you recommend this?
• What are the risks for someone with my history?
• What would a gentler option look like?
• What should I watch for after a visit, and when should I call?

Find out what's behind your neck pain

You want your neck to feel better, and you also want to feel safe getting there. Both matter. You shouldn't have to choose between relief and peace of mind.

We're here to help you sort it out. Chiropractic Company has cared for Greater Milwaukee since 1982, with 400,000+ patients, 1,400+ five-star Google reviews, and 20+ neighborhood clinics. We look for the cause of your neck pain, not just the symptoms. Your doctor explains what they find, talks through the risks and benefits, and answers every question. You choose your care, and you see the same doctor as it continues.

Care is natural and drug-free. Treatment begins at your second visit, or the same day in acute cases if your doctor decides it's appropriate. Some plans add physical therapy at our Menomonee Falls, Waukesha, and West Allis North clinics, or massage therapy at Hales Corners and Oconomowoc.

We're in-network with most insurance companies and accept Medicare and auto accident claims. Eligible new patients can start with the $29 new-patient special, which includes a consultation, an exam, and X-rays if needed. *See offer terms.

Visit one of our 20+ neighborhood clinics across Greater Milwaukee: Milwaukee East, Milwaukee North, Milwaukee Third Ward, Shorewood, Glendale, Mequon, Cedarburg, Grafton, Germantown, Brookfield, Menomonee Falls, Waukesha, Oconomowoc, New Berlin, West Allis, West Allis North, Greenfield, Hales Corners, Franklin, Muskego, and Cudahy.

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