Is It Safe to Get Your Neck Adjusted? What the Research Actually Says About Chiropractic and Stroke

One of the most common questions I hear from new patients is: 

"Can a chiropractic adjustment cause a stroke?" 

It's an understandable concern. Stories shared on social media and in the news can be frightening, and many people have heard someone say they "know someone" who had a stroke after seeing a chiropractor. 

As a healthcare provider, I believe patients deserve honest conversations—not fear-based headlines. 

The good news is that we now have decades of research examining this question. While no healthcare intervention is completely risk-free, the current evidence paints a very different picture than many people believe. 

Where Did This Fear Come From? 

The concern centers around a condition called cervical artery dissection (CAD)—a tear in the lining of one of the arteries supplying blood to the brain. 

If a blood clot forms within the tear, it can lead to a stroke. 

Because many patients develop sudden neck pain or headache as one of the first symptoms of an artery dissection, they often seek care from a chiropractor, primary care physician, or emergency department before the stroke occurs. 

This timing has made it difficult for researchers to answer an important question: 

Did the adjustment cause the dissection, or was the patient already experiencing a dissection before seeking treatment? 

What Does the Research Say? 

This question has been studied extensively for more than two decades. 

A 2016 systematic review and meta-analysis evaluating all available evidence found no convincing evidence that chiropractic manipulation causes cervical artery dissection. While some observational studies found an association, the authors concluded that the available evidence was of very low quality and that the observed relationship was most likely explained by patients already experiencing neck pain from an evolving artery dissection before seeking care.  

Similarly, a large population-based study comparing chiropractic visits with primary care visits found no excess risk of vertebrobasilar stroke following chiropractic care compared with visiting a primary care physician. Researchers concluded that patients with an already developing artery dissection frequently seek care because of their neck pain or headache—not because treatment caused the dissection. 

More recent reviews published in 2024 reached similar conclusions, finding no convincing evidence that cervical spinal manipulation causes cervical artery dissection in a healthy cervical spine. Instead, these reviews emphasize the importance of recognizing symptoms that may indicate a dissection is already occurring before any treatment is performed.

How Common Are Serious Complications? 

The most reassuring finding is that serious complications following chiropractic spinal manipulation are  extremely uncommon. 

Published estimates vary because these events are so rare and difficult to study, but serious adverse events —including stroke—have been estimated to occur anywhere from approximately 1 in 100,000 to 1 in several million cervical manipulations, depending on the study design and definitions used. Researchers agree that precise estimates remain challenging because these events are exceptionally uncommon.  

Like every healthcare profession, chiropractors carry malpractice insurance. If catastrophic injuries were occurring at the frequency often portrayed online, malpractice premiums would reflect that risk. While insurance costs alone do not prove safety, they are consistent with the published literature showing that serious adverse events are exceedingly rare.

Every Healthcare Treatment Has Risks 

No healthcare treatment is completely without risk. Prescription medications can cause allergic reactions, gastrointestinal bleeding, kidney injury, or dependence. 

Common surgical procedures carry risks of infection, blood clots, anesthesia complications, and other serious adverse events. Even over-the-counter medications such as ibuprofen or acetaminophen can lead to significant complications when used improperly. The goal in healthcare is never to find a treatment with zero risk—because none exists. 

Instead, healthcare providers weigh the potential benefits against the known risks and choose the safest, most appropriate treatment for each individual patient. 

How I Keep My Patients Safe 

Patient safety always comes first. 

Before performing any chiropractic adjustment, I complete a thorough history and physical examination to determine whether manipulation is appropriate. 

I specifically screen for: 

• Sudden, unusual neck pain or headache 

• Neurological symptoms History of trauma 

• Vascular risk factors 

• Signs that suggest a condition requiring medical referral rather than chiropractic care 

If I suspect something more serious than a musculoskeletal condition, I do not perform an adjustment. My responsibility is to ensure you receive the right care, even if that means referring you for emergency medical evaluation or advanced imaging. 

Dr. Tannaz's Clinical Perspective 

One of my favorite conversations with nervous patients usually ends with a smile. They'll ask, 

"Have you ever had someone get a stroke from an adjustment?" 

I tell them the truth: 

"In my career, my goal has always been to help people get out of pain—not put them in danger." 

The research supports what I see every day in practice. Serious complications from chiropractic care are extraordinarily rare, and the overwhelming majority of patients experience safe, conservative care for musculoskeletal pain. That doesn't mean chiropractors should ignore risk. It means we should respect it.

Good chiropractors don't simply adjust everyone who walks through the door. We evaluate, screen, educate, and determine whether chiropractic care is appropriate before treatment begins. 

That's what evidence-based practice looks like. 

References 

1.  Church EW, Sieg EP, Zalatimo O, et al. Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection. Cureus. 2016. 

2.  Cassidy JD, Boyle E, Côté P, et al. Risk of Vertebrobasilar Stroke and Chiropractic Care. Spine. 2008. 

3.  National Institute for Health and Care Excellence (NICE). Low Back Pain and Sciatica in Over 16s: 

Assessment and Management. 

4.  Wynd S, Westaway M. Cervical Spine Manipulation and Causation of Cervical Artery Dissection: A Review of 10 Case Reports. 2024.