Finding the Middle Ground: The Cervical Adjustment Debate

Ah, let us begin with one of the most divisive topics in all of chiropractic! The one where you either love it or you hate it and rarely is there any bit of middle ground. The cervical adjustment!

For most, it’s a wonderful feeling and a great eliminator of their discomfort. It’s just the thing for their neck pain or their headaches. But for some, it’s a bridge too far, something that they “will never allow to happen” to them. The idea of this procedure would surely be the cause of a stroke or even a broken neck. Others just dislike the noise that is made during the adjustment. Very interesting indeed how much the two sides are entrenched and often unable to see eye to eye. The question is, is there a correct side?

Let’s start with a simple comparison. Found in literature as early as 1993, a condition known as Beauty Parlor Syndrome was indicated as a possible cause of strokes. In this condition, women who had recently been to their local hairdresser, were developing strokes. These incidents often occurred after having their hair shampooed, with their heads placed in extension for longer periods of time. Aneesh Singhal, M.D., associate professor of neurology at Harvard Medical School and vice chair of Neurology at Massachusetts General Hospital, says this kind of thing can also happen to people when they’re at the dentist, playing tennis and even doing yoga.[1] And yes, one could compare the extension and force upon the neck in these situations to chiropractic adjustments, but medical doctors are quick to point out that this condition is uncommon. I don’t disagree with this assessment at all. I am in no way saying that anyone needs to be worried about going to their hair stylist. As I am losing my hair, I don’t have to go as often but I know what an incredible role these professionals play in the lives of their clients and the thought of this should not cross anyone’s minds. What I am arguing for is that the same consideration that is given to this “Beauty Parlor Syndrome” be given to chiropractors, since that is what the science continues to point to.

I won’t lie, there isn’t a perfect research article out there that shows x=y therefore y=z. But what is out there shows that there is a vast difference between the amount of force needed to cause injury and the actual force used in a chiropractic cervical adjustment. Walter Herzog, an expert in biomechanics of spinal manipulation, showed that the average force used for a cervical adjustment was around 100 N.[2] and that the force applied during a cervical adjustment is less than the force exerted through normal range of motion. Herzog also revealed that the amount of force needed to injure blood vessels in the neck is 200-400 N, or at least twice as much, if not 4x the amount of force in an adjustment. Most of the literature points to a very weak, if not non-existent connection between the chiropractic adjustment and strokes. Whedon et. al. showed, “…incidence of vertebrobasilar stroke was extremely low. Small differences in risk between patients who saw a chiropractor and those who saw a primary care physician are probably not clinically significant.”[3] There is a saying in the research world, correlation doesn’t equal causation. As you can see, causation isn’t necessarily guaranteed with the current research. So let’s look at why there is an, oftentimes, false correlation between the two.

So doc, that’s great and all but what about the connection between chiropractors and strokes? It’s a fair and valid question and chiropractors do play a role in this equation. First off, let’s look at some of the common symptoms people experience when they are having a vertebral artery dissection. Three of the most common are neck pain (usually one sided), headaches (severe in most cases) and dizziness.[4] None of those are fun to have. When people have these symptoms, they want nothing more than for them to be gone. Not surprisingly, these are three common symptoms that patients reach out to chiropractors to help relieve. In most cases, the chiropractor is likely to be the first stop on their journey for relief. And just as is the case with Beauty Parlor Syndrome, patients with an underlying issue with their blood vessels in their neck don’t know the extent or exactly what is causing the symptoms. This is where we, as chiropractors, have to do better. It’s inevitable that every few years, a story about a patient having a stroke after seeing their chiropractor makes national headline news. It’s never good for the patient, their family or the chiropractor. No chiropractor ever wants to hurt their patient, especially to that extent. The news, TV or print, is always quick to portray that going to the chiropractor is a dangerous game of russian roulette. Nevermind that research shows that severe adverse events occur in 1.56-2.68 per 10 million interventions (i.e. adjustments).[5] Just for contrast, it is estimated that there are approximately 106,000 deaths each year from properly taking medication.[6] I would never state that chiropractic is without risk, heck, life itself is full of risk but the risk is not what the sensationalized media would portray. With that said, it is on us as chiropractors to properly screen our patients who come in with these types of symptoms. They are coming to us for their health and it is imperative that we take the time to properly assess their condition and make sure that the adjustment is appropriate for that particular treatment.

As a chiropractor, that is exactly what I do at BMC Family Chiropractic. In any job, one of the hardest things is staying present. I strive each and every day to maintain what Jim Parker called, “Present Time Consciousness” or PTC so that each and every person that walks through our office door gets the best and most appropriate treatment that I can offer. Obviously my ears perk up when I hear certain presenting symptoms and when that happens I make sure to further investigate to see if there is any underlying pathology. I have had multiple cases where we have sent patients out for advanced imaging before any adjustments were given, especially in the neck. Only until I am 100% confident that my adjustment will be safe, will I actually adjust. Your health is too important to not do that. It’s also one of the reasons that I try to have our patients really take control of their health and be a part of the discussion. I encourage them to ask questions and to share with me what is happening and what they are feeling. By really listening to them, it helps me have a better understanding of what they are experiencing and ultimately helps me provide them better care. Heck, I even have a very small portion of patients that will not allow the “traditional” diversified adjustment of their cervical spine. Luckily, with over 200 chiropractic techniques, it’s easy to work together to find one that is effective for them, while still removing any subluxations that are present. In short, don’t let this small thing be the reason you aren’t receiving chiropractic care. There are many ways to do things and the benefits of chiropractic care far outweigh the risks that are associated with it! If you have any questions, please feel free to call us at our office, 303-284-7724 and we will be happy to answer those questions for you!



[2] Walter Herzog, The biomechanics of spinal manipulation, Journal of Bodywork and Movement Therapies, Volume 14, Issue 3, 2010, Pages 280-286,

[3] Whedon JM, Song Y, Mackenzie TA, Phillips RB, Lukovits TG, Lurie JD. Risk of stroke after chiropractic spinal manipulation in medicare B beneficiaries aged 66 to 99 years with neck pain. J Manipulative Physiol Ther. 2015 Feb;38(2):93-101. doi: 10.1016/j.jmpt.2014.12.001. Epub 2015 Jan 14. PMID: 25596875; PMCID: PMC4336806.


[5] Whedon JM, Toler AWJ, Goehl JM, Kazal LA. Association Between Utilization of Chiropractic Services for Treatment of Low Back Pain and Risk of Adverse Drug Events. J Manipulative Physiol Ther. 2018 Jun;41(5):383-388. doi: 10.1016/j.jmpt.2018.01.004. Epub 2018 May 26. PMID: 29843912.

[6] Starfield B. Is US health really the best in the world? JAMA vol. 284 No. 4. July 26, 2000.

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