Concerns With Getting Your Neck Cracked? Let’s Explain the Safety Behind It!
If you’ve ever winced at the sound of a neck ‘crack’ or hesitated to try cervical adjustments because of scary headlines, you’re not alone.
At Summit Physio and Performance, we hear these concerns daily and we get it. No one wants to take risks with their spine. But here’s the good news: decades of research and clinical experience show that cervical manipulation, otherwise known as a neck adjustment, when performed by a trained professional, is not only safe but can be one of the most effective tools for relieving neck pain and restoring mobility and reducing pain. In this blog, we’ll cut through the noise, address the real risks (and why they’re rare), and share how our team prioritizes your safety above all else.
Let’s start with the basics: what exactly is a cervical manipulation?
Cervical manipulation, also known as a neck adjustment, is a manual therapy technique used to improve joint mobility, reduce muscle tension, and relieve pain in the cervical spine or neck region. It involves a precise, quick and controlled movement applied to a joint that is not moving well. That familiar “crack” or “pop” sound that can sometimes happen is simply gas being released from the joint space. It is similar to cracking your knuckles and is not harmful.
The specific technique often used is called high velocity low amplitude (HVLA) manipulation. This means the movement is delivered quickly but with a very small range of motion. It is not about force or intensity but about speed and precision. We like to think of it as a quick stretch to the area we are treating. When performed by a trained and licensed clinician, HVLA manipulation is safe, targeted, and designed to restore normal joint motion without excessive strain.
This approach is often used when joints in the neck become stiff or restricted, which can happen after injuries, poor posture, or long periods of immobility such as working at a desk all day. It can also be effective for reducing the frequency and intensity of cervicogenic headaches, which stem from dysfunction in the upper cervical spine. In certain cases of cervical radiculopathy, where nerve irritation is causing pain or numbness to radiate down the arm, manipulation can be part of a broader strategy to help restore space and mobility and improve local inflammation around the affected nerve root. Nerves are very sensitive to chemical inflammation, and are often more pressure tolerant than one may think. The manipulation can help diffuse inflammation which in turn can help with pain and improve symptoms traveling down the arm or arms.
At our clinic, we use cervical manipulation as one of many tools to help you move better, feel better, and get back to doing what you love—whether that is hitting a new PR or just getting through your workday without neck tension or pain
Is Cervical Manipulation Safe?
Now, let’s talk about the elephant in the room—the stroke thing.
There have been RARE cases of vertebral artery dissection (VAD) following cervical manipulation. A 2003 study by Smith and colleagues found a possible association, even after accounting for people who already had head or neck pain. In a few instances, symptoms of a stroke appeared shortly after treatment. These cases are important and deserve attention, but here’s the reality: it happens, and it is extraordinarily rare.
Just how rare?
Research estimates the risk of serious adverse events between 1 in 20,000 and 1 in 10 million. When you average the data from several large studies, it comes out to about 1 in 2 million or .00005%. For context:
Your odds of getting struck by lightning are 1 in 1.2 million
Running a marathon carries a 1 in 150,000 risk of death
Taking NSAIDs for neck pain? According to a 1995 study by Dabbs, the risk of serious complications or death is 100 to 400 times higher than with cervical manipulation
Let that sink in for a second. A lightning strike is more likely. A marathon is significantly riskier. And the over-the-counter meds many people reach for without hesitation? Statistically far more dangerous.
So while no treatment is entirely without risk, the overwhelming evidence shows that cervical manipulation—when performed by a licensed and trained clinician—is a safe, evidence-supported option for addressing neck pain, headaches, and even some nerve-related symptoms. In other words, you are far more likely to strain your neck turning your head to look in your blind spot than you are to experience a serious event after an adjustment.
What Happens to Blood Flow During Cervical Manipulation?
A common concern when it comes to neck adjustments is how it affects the arteries in the neck, specifically the vertebral artery and the internal carotid artery. These arteries supply blood to the brain, and when someone has a stroke, it’s often because blood flow to the brain is disrupted in some way.
So, what happens when you rotate your neck, especially during cervical manipulation? Well, a 2015 study by Thomas and colleagues looked into this very thing. They used MRI scans to measure how blood flows through these arteries when someone rotates their neck fully, to see if it changes at all.
Here’s the takeaway: While rotating your neck can change blood flow in these arteries, the study found that it doesn’t have a major impact on the overall blood flow to the brain. In simpler terms, even though there’s a small change in blood flow when you turn your head, your body is great at making sure the brain still gets the blood it needs. This is because your brain has multiple ways of compensating—if one artery slows down a little, others pick up the slack. This keeps your brain's blood supply stable, even with neck movements.
What does this mean for you?
If you have normal, healthy blood vessels, your body’s built-in systems can handle those minor changes in blood flow during neck rotations.
So how do we make sure we are doing this safely? Screening is everything.
At Summit Physio and Performance, we take screening seriously. We do not perform cervical manipulation on everyone with a stiff or painful neck. We take the time to dig into your history, rule out red flags, and evaluate whether manipulation is truly appropriate for you. If anything seems off, we refer immediately to the right medical provider.
We carefully screen for symptoms of vertebral and internal carotid artery dissection before any hands-on treatment. Here is what we look for:
Symptoms that might suggest vertebral artery dissection:
New or unusual neck pain or headache, especially in the back of the head
Dizziness, difficulty speaking or swallowing, nausea, nystagmus, facial numbness, imbalance
Loss of strength, hearing disturbances, trouble with memory or coordination
Symptoms that might suggest internal carotid artery dissection:
Horner's syndrome (droopy eyelid, small pupil, lack of sweating on one side)
Pulsatile tinnitus (hearing a heartbeat in your ear)
Vision issues or temporary vision loss
Cranial nerve palsies (issues with nerves that control the face and throat)
We also follow evidence-based tools like the Canadian C-Spine Rules to help determine if imaging or medical referral is necessary before initiating any manual therapy. These rules help identify when there might be a fracture or more serious condition needing further investigation.
Research supports the importance of this approach. A prospective study found that 71 percent of patients with cervical artery dissection had a recent minor neck strain or trauma. They were 60 times more likely to report this compared to people who had strokes not caused by dissection. Another study by Puentedura (2011) found that nearly 45 percent of adverse events from cervical manipulation were preventable with better screening, and almost 20 percent of those patients should never have received the technique in the first place.
Our takeaway? Be thorough. Be cautious. Be smart. That is what we do every day.
Final Thoughts: Safety, Trust, and Effective Care
Cervical manipulation, like any clinical tool, requires skill, training, and thoughtful decision-making. At Summit Physio and Performance, we do not take that responsibility lightly. The research shows that while serious adverse events are extraordinarily rare, the best way to keep them that way is through proper screening, informed patient care, and clinical expertise.
We use this technique not because it is trendy or flashy, but because it works. From reducing neck pain and restoring range of motion to relieving headaches and even improving symptoms of cervical radiculopathy, cervical manipulation can be a powerful part of a patient’s recovery journey. But it is never a one-size-fits-all approach. We assess, we screen, and we adapt based on your unique presentation and health history.
Still unsure if it is right for you? Have questions about your symptoms or concerns? That is exactly what we are here for. Reach out to our team anytime. Whether or not manipulation is part of your treatment plan, you can trust we will guide you safely, confidently, and with your best interest in mind every step of the way.
Dr. Cat Cui, PT, DPT
