The dangers of neck cracking
To follow-up on the discussion on to stop or not to stop.
Maybe some joints are more dangerous to crack than others. There is little doubt that knuckle cracking has been extensively studied to pose little harm but what about the neck which seems like the most dangerous?
In this thread I'll take a closer look at neck cracking and possible dangers to evaluate how real these are. :roll:
To be fair the article carries the subtitle "Should Chiropractors Warn of Real but Small Danger?".
I'll post the article in full with the interesting bits marked in bold as usual.
May 12, 2003 – If you've got a pain in the neck, think twice about getting your neck cracked. **Spinal manipulative therapy, as chiropractors call it, increases your risk of stroke.
The overall risk is probably very small. But the link between stroke and neck cracking is real, says neurologist Wade S. Smith, MD, PhD, director of the neurovascular service at the University of California, San Francisco.**
"Some neurologists think chiropractors are causing a lot of strokes, but we think it is a very low risk," Smith tells WebMD. "I don't think it is so low that a patient doesn't need to be informed about it. The consequences of a stroke can be enormous. People should be aware that spinal manipulation increases risk of stroke. Anybody who does a procedure of any kind that carries a risk should tell their patients about that risk."
One of the leading causes of stroke before age 45 is something called cervical arterial dissection. That's when one of the two arteries that wind through the back of the neck to the brain starts to tear. The lining of the artery bleeds and forms a blood clot. This clot can easily enter the brain and cause a fatal stroke.
Earlier studies in Canada compared stroke registries with medical records. Strokes in younger adults were strongly associated with seeing a chiropractor. Was there a real cause-and-effect connection? Smith looked for more evidence.
His team looked at all patients under the age of 60 who from 1995-2000 visited two large medical centers for cervical dissections resulting in strokes or the passing stroke-like episodes called transient ischemic attacks. They found 151 such patients; 51 were available for study. The patients were compared with 100 age-matched patients whose strokes were not due to arterial dissection. All were asked a battery of questions – including whether they had head or neck pain in the 30 days before their stroke, and whether they got a spinal manipulation during that time.
Of the 51 patients, seven (14%) remembered getting their necks cracked before their stroke. Only 3% of the control patients remembered seeing a chiropractor in the month before their stroke. After controlling for all other factors, getting a spinal adjustment upped the risk of stroke 6.62-fold.
"If a person has any of the symptoms of stroke, he or she should bypass the chiropractor and go directly to the hospital," Smith says.
These red flags are:
- One side of the body becomes weak, numb, or paralyzed.
- Double vision, blurry vision, or loss of sight.
- Trouble speaking or difficulty understanding speech.
- Loss of balance or coordination; dizziness.
- Sudden severe headache.
"Neck cracking," or cervical spinal manipulation, is the chiropractic technique that most concerns neurologists. To make this adjustment, the practitioner often gives the neck a high velocity twist. Chiropractors are trained to know the anatomy of the neck. Other kinds of practitioners, Smith says, may not be so well aware of the risks. He notes that many chiropractors already are adopting a less forceful technique for cracking necks.
Scott Haldeman, DC, PhD, MD, is a chiropractor as well as a neurologist. As clinical professor of neurology at the University of California, Irvine, he's studied many cases of arterial dissection in chiropractic patients.
Haldeman says the Smith study has a major weakness: It relies on patients' memories of events years in the past. Also, he notes that even though the study took place in California – where people do more spinal manipulations than anywhere else -- only seven cases of stroke could be linked in any way to neck cracking.
"I think the basic information in the Smith study is very important. It does confirm that there is a temporal relationship between stroke and spinal manipulation that we cannot rule out," Haldeman tells WebMD. "But their evidence that spinal manipulation is a major cause of stroke is weak. The risk is not zero, and none of us is suggesting there isn't some risk. What we have basically got here is a situation we have to put into perspective."
If you have neck pain, Haldeman asks, what are you supposed to do? Taking aspirin or ibuprofen puts you at small but real risk of getting an ulcer. No other medication is proven to work. Surgery is unproven and has its own risks. However, Haldeman says, there is evidence that exercise and spinal manipulation can ease neck pain in the short term.
"At the end of last week I was having neck pain," Haldeman says. "I know very well there is a risk of complication, but I didn't want to go through the weekend with my neck hurting. So on Saturday, I had an adjustment on my neck."
According to this report the risk of a stroke due to neck cracking is very low without a solid correlation. I'm kinda glad considering how often I cracked my neck today alone. :lol:
I wonder what this "high-velocity twist technique" looks and feels like. Better not try it alone at home!
I've also heard it's possible to hurt yourself through cracking your back, and technically feasible to kill yourself through improper cracking of your neck (through rupturing of your carotid or something).
This seems to hit the same nail the above article did. The "Carotid arteries" are Arteries in your neck that supply blood to the brain.
If you rupture these through "improper" neck cracking a blob of blood could travel up your brain, clog it and cause a deadly stroke.
However, according to the article already posted, this risk seems to be very minimal at best.
I just found another very indepth article by Stephen Barrett, M.D. written on January, 2004 called Chiropractic's Dirty Secret: Neck Manipulation and Strokes on quackwatch.org.
Stroke from chiropractic neck manipulation occurs when an artery to the brain ruptures or becomes blocked as a result of being stretched. The injury often results from extreme rotation in which the practitioner's hands are placed on the patient's head in order to rotate the cervical spine by rotating the head . The vertebral artery, whch is shown in the picture to the right, is vulnerable because it winds around the topmost cervical vertebra (atlas) to enter the skull, so that any abrupt rotation may stretch the artery and tear its delicate lining. The anatomical problem is illustrated on page 7 of The Chiropractic Report, July 1999. A blood clot formed over the injured area may subsequently be dislodged and block a smaller artery that supplies the brain. Less frequently, the vessel may be blocked by blood that collects in the vessel wall at the site of the dissection .
Chiropractors would like you to believe that the incidence of stroke following neck manipulation is extremely small. Speculations exist that the odds of a serious complication due to neck manipulation are somewhere between one in 40,000 and one in 10 million manipulations. No one really knows, however, because (a) there has been little systematic study of its frequency; (b) the largest malpractice insurers won't reveal how many cases they know about; and a large majority of cases that medical doctors see are not reported in scientific journals.[…]
I'll dissect this here in more detail later, but for now I gotta go. Of course anyone is welcomed to dissect this article for me! :lol:
From my initial screens the dangers seems to be more serious after all.
good research JC,
Just to be random-
my neck clicked 4 times today all at the same time while i was driving, and now its stop hurting and i think my whiplash has been mildly cured. Lol
I can see the logic in it being dangerous tho.
Crap… mine gets stiff and needs to be cracked all the time. Like right now. pop
Good advice JC
I've noticed myself the neck is one of the few joints that's easier to make hurt or get stiff if not cracked correctly, and is harder to crack. When I crack it, I tend to just do so without hands. I lean the head left or right to make it crack, and on the rare occasions I use hands I put one hand under the chin and the other on the top side of the head, so it's steadied. I try to be pretty careful when doing so, and have a careful delay before cracking it, where I ready to do so. The neck obviously is going to be the most delicate and dangerous joint to crack, and should be done so with more care then any of the others.
I def believe this and i think neck is dangerous as it always feels weird after you begin with the morning crack. I also think that sternum, ribs and hips would be very bad too.