Letting chiropractor `crack` your neck to relieve pain could trigger stroke

Neck ‘cracking’ could trigger "catastrophic" health problems such as strokes, experts have warned.

The common therapy to ease pain is “clinically unnecessary” and should be abandoned for an affliction that affects two in three people at some point in their lives.

Its effectiveness divides medical opinion with some doctors even believing it helps lower blood pressure.

Known scientifically as spinal manipulation, the technique involves the application of various types of thrusts to the lumbar spine for the lower back or cervical spine for the neck to reduce back, neck and other musculoskeletal pain.

However, physiotherapy lecturer Neil O’Connell, of Brunel University, Uxbridge, and colleagues have warned that cervical spine manipulation “may carry the potential for serious neurovascular complications".

Writing online in the British Medical Journal, they added that the technique is “unnecessary and inadvisable".

Neck pain, often caused by stress, affects one in 10 people in Britain at any one time.

“Spinal manipulation is different from a gentle massage.It is where your neck is extended to its extremity and pushed with force to produce that sudden and familiar ‘clickink’ sound,” the Telegraph quoted O’Connell as saying

“There have been rare cases where a specific type of stroke has happened within a few days of the treatment which can tear the lining of the vertebral artery in the neck supplying blood to the brain.

“Studies have shown that other types of treatment, such as a gentle massage or exercise, are just as effective without the risks. None of them are a panacea, there is no reliable cure for neck pain, but all provide just the same amount of relief,” he said.

He further added that there is consistent evidence of an association between damage to the major blood vessels supplying the brain, brainstem and upper spinal cord, known as neurovascular injury, and recent exposure to neck massage.

O’Connell said that it is unlikely to offer meaningful long term benefit for people with neck pain.

And other recent large, high quality trials reinforce this message, suggesting massage is not better when directly compared with other physical interventions such as exercise. Given the equivalence in outcome with other forms of therapy, manipulation seems to be clinically unnecessary, he said.

“The potential for catastrophic events and the clear absence of unique benefit lead to the inevitable conclusion that manipulation of the cervical spine should be abandoned as part of conservative care for neck pain,” O’Connell said.

But epidemiologist Professor David Cassidy, of the University of Toronto, and colleagues also said that neck manipulation does provide a valuable addition to patient care and should continue to play an important role in therapy.

They pointed to high quality evidence that “clearly suggests that manipulation benefits patients with neck pain” and raises doubt about any direct relation between the treatment and stroke.

When combined with recent randomised trial results, “this evidence supports including manipulation as a treatment option for neck pain, along with other interventions such as advice to stay active and exercise,” they said.

Yet they acknowledged that when risk, benefit and patient preference are considered “there is currently no preferred first line therapy, and no evidence mobilisation is safer or more effective than manipulation".

“We say no to abandoning manipulation and yes to more rigorous research on the benefits and harms of this and other common interventions for neck pain,” they added.