Can Neck Chiropractic Adjustments Cause a Stroke? UAE Spine Surgeon Warns

Neck pain drives many people in Dubai and across the UAE to seek relief through chiropractic adjustments. These manual treatments, which involve quick twisting movements of the neck, are popular and widely available. But can they actually cause a stroke?

Dr. Sherief Elsayed, a senior UK-trained spinal surgeon practicing in the UAE, addresses this controversial question with balanced, evidence-based guidance. “The relationship between neck manipulation and stroke is real but complex,” he explains. “Understanding the risks, knowing the warning signs, and making informed choices about your neck care is essential.”

This article explores the scientific evidence on chiropractic neck adjustments and stroke risk, explains the anatomy behind this connection, and provides practical guidance for people seeking safe treatment for neck pain.

What exactly happens during a chiropractic neck adjustment?

To understand the potential risks, it helps to know what actually happens during a cervical manipulation, the medical term for chiropractic neck adjustment.

During this procedure, a chiropractor or other manual therapist places their hands on your neck in a specific position, then applies a quick, controlled force that rotates or extends your neck beyond its normal range of motion. You often hear a popping or cracking sound, which comes from gas bubbles releasing in the joint fluid, not from bones cracking.

The intended goal of this manipulation is to:

• Restore normal joint movement
• Reduce muscle tension and spasm
• Decrease pain signals
• Improve neck mobility
• Address joint dysfunction or misalignment

Chiropractors perform millions of these adjustments worldwide every year. For many people, they provide relief from neck pain, headaches, and muscle tension. The treatment is generally quick, non-invasive, and can feel immediately satisfying when you hear and feel the release.

However, the neck is a complex and delicate region. Unlike your lower back, which can tolerate more forceful manipulation relatively safely, your neck contains vital structures that can be damaged by high-velocity movements.

How could a neck adjustment possibly cause a stroke?

The connection between neck manipulation and stroke involves the vertebral arteries, two major blood vessels that run up each side of your neck inside the bones of your cervical spine. These arteries supply blood to the back part of your brain, including areas that control balance, coordination, and consciousness.

Here’s what can go wrong:

Arterial dissection: The rapid twisting and extension movements during neck manipulation can stretch and tear the inner lining of the vertebral artery. This creates a flap of tissue inside the artery where blood can pool between the layers of the arterial wall. This is called a dissection.

Once a dissection occurs, several dangerous things can happen:

Blood clot formation: The torn area in the artery wall creates an abnormal surface where blood clots can form. These clots can then break off and travel upstream to the brain.

Artery narrowing or blockage: The dissection itself can narrow or completely block the artery, reducing blood flow to the brain.

Brain stroke: When brain tissue doesn’t receive enough oxygen-rich blood, either because of a traveling clot or reduced blood flow, brain cells begin to die. This is a stroke.

The type of stroke associated with neck manipulation is typically an ischemic stroke, meaning it’s caused by blocked blood flow rather than bleeding. The areas of the brain supplied by the vertebral arteries include the brainstem and cerebellum, which control vital functions like breathing, heart rate, balance, and coordination.

“The anatomy of the neck makes it particularly vulnerable,” Dr. Sherief Elsayed explains to his Dubai patients. “The vertebral arteries travel through small holes in your neck bones and make several sharp turns. When the neck is forcefully rotated and extended, these arteries stretch and twist. In some people, this mechanical stress is enough to cause damage.”

Certain factors make some people more vulnerable to arterial dissection:

Connective tissue disorders: Conditions like Ehlers-Danlos syndrome that affect the strength of blood vessel walls

High blood pressure: Weakens arterial walls over time

Previous arterial problems: History of dissection or aneurysm

Atherosclerosis: Hardening of the arteries makes them less flexible

Recent infection or inflammation: Can weaken blood vessel walls temporarily

Age: Younger adults, particularly under 45, appear to be at higher risk for dissection-related stroke

What does the research actually say about the risk?

The relationship between chiropractic neck manipulation and stroke has been studied extensively, but the research presents a complex picture. Here’s what we know:

Documented cases exist: Medical literature contains well-documented cases of stroke occurring shortly after neck manipulation. Some patients experienced symptoms during or immediately after the manipulation, while others developed symptoms hours or days later. These case reports establish that the association is real, not theoretical.

The absolute risk is low: Large population studies suggest that cervical manipulation-related stroke is rare. Estimates vary, but most research suggests approximately 1 to 3 strokes per 100,000 neck manipulations. To put this in perspective, you’re statistically more likely to be struck by lightning than to have a stroke from a neck adjustment.

The causation question is complex: Here’s where it gets complicated. Some research suggests that people who are already in the process of having a vertebral artery dissection may seek care for neck pain or headache, which are early symptoms of dissection itself. In other words, they go to the chiropractor because they’re already having a dissection, and the stroke that follows may have happened regardless of the manipulation.

Other studies counter this by showing a temporal relationship, meaning strokes occur very close in time to the manipulation, suggesting the manipulation triggered the event rather than just coinciding with it.

Age patterns are revealing: Research shows that stroke after neck manipulation is more common in younger adults under 45, while stroke in general is much more common in older adults. This age pattern suggests the manipulation plays a causative role, since spontaneous vertebral artery dissection, while more common in younger people, is still quite rare.

Risk comparison matters: Some researchers compare the stroke risk from neck manipulation to the baseline risk of stroke in people seeking care for neck pain. The data shows a slightly increased risk in the days following manipulation compared to those who don’t receive manipulation, though the absolute risk remains low.

Dr. Sherief Elsayed emphasizes that statistical risk and individual risk are different concepts. “Saying the risk is 1 in 100,000 might sound reassuring, but if you’re the one person it happens to, that statistic offers no comfort,” he notes. “This is why careful patient selection, recognizing warning signs, and considering safer alternatives is so important.”

A 2001 study in the Canadian Medical Association Journal found that people under 45 who had a stroke with vertebral artery dissection were about five times more likely to have visited a chiropractor in the week before the stroke compared to control patients. While this doesn’t prove causation definitively, it suggests a meaningful association.

More recent systematic reviews have called for better study design and acknowledge that current evidence can’t provide a precise risk estimate. What is clear is that while rare, the risk is real and the consequences can be devastating.

What are the warning signs of vertebral artery dissection that I should never ignore?

Vertebral artery dissection often produces warning symptoms before a major stroke occurs. Recognizing these symptoms is critical because they indicate a medical emergency.

The “5 H’s and N’s” of dissection symptoms:

Headache: Often described as sudden, severe, and unlike any headache you’ve experienced before. The pain is typically at the back of the head or neck and may be one-sided. This is the most common early symptom, occurring in up to 70 percent of vertebral artery dissections.

Head or neck pain: Severe neck pain, particularly on one side, that comes on suddenly. The pain might feel deep and aching rather than muscular.

Horner’s syndrome: A combination of a drooping eyelid, small pupil, and decreased sweating on one side of the face. This occurs when the dissection affects sympathetic nerves that run along the artery.

Hearing problems: Sudden hearing loss, ringing in the ears, or a whooshing sound in rhythm with your heartbeat on one side.

Hiccups: Persistent, intractable hiccups can indicate brainstem involvement.

Neurological symptoms: These indicate that the dissection has progressed to cause stroke and include:

• Sudden dizziness or vertigo
• Loss of balance or coordination
• Double vision or visual problems
• Difficulty speaking or slurred speech
• Numbness or weakness in the face, arm, or leg
• Difficulty swallowing
• Nausea and vomiting

Timing matters: These symptoms may appear during or immediately after neck manipulation, or they may develop hours to several days later. The gradual progression from neck pain and headache to neurological symptoms reflects the natural history of dissection: first the artery tears, then over hours or days, a clot forms or the dissection extends, eventually causing stroke.

“If you develop severe headache, neck pain, or any neurological symptoms during or after any type of neck manipulation, stop the treatment immediately and seek emergency medical care,” Dr. Sherief Elsayed advises. “Don’t wait to see if it gets better. With stroke, time is brain. Every minute counts.”

In the UAE, if you experience these symptoms, call 998 for emergency services or go immediately to the nearest hospital emergency department.

Are some people more at risk than others for complications from neck manipulation?

Yes, certain people face higher risks from cervical manipulation and should either avoid it entirely or proceed with extreme caution.

People who should avoid high-velocity neck manipulation:

Those with known vascular disease: If you have a history of arterial dissection, aneurysm, or significant atherosclerosis, the stress of manipulation could trigger a vascular event.

People with connective tissue disorders: Conditions like Ehlers-Danlos syndrome, Marfan syndrome, or osteogenesis imperfecta affect the structural integrity of blood vessels, making them more susceptible to damage.

Individuals with uncontrolled high blood pressure: Elevated blood pressure puts extra stress on arterial walls and increases the risk of dissection.

Anyone with vertebrobasilar insufficiency: This condition means reduced blood flow through the vertebral arteries. Symptoms include dizziness with neck movements, drop attacks, or vision problems. Manipulation could worsen an already compromised blood supply.

People taking blood thinners: While blood thinners don’t increase the risk of arterial dissection itself, if a dissection does occur, the consequences could be more severe because of increased bleeding risk.

Those with recent neck trauma: Car accidents, falls, or sports injuries that affected the neck may have already damaged the vertebral arteries, making them more vulnerable to further injury.

People with active neck pain with neurological symptoms: If your neck pain is accompanied by arm numbness, weakness, or tingling, this suggests nerve root or spinal cord involvement. Manipulation could worsen these symptoms.

Patients with cervical spine instability: Conditions like rheumatoid arthritis, Down syndrome, or previous neck surgery may have weakened the structural stability of the cervical spine.

Risk factors that warrant caution:

Beyond absolute contraindications, some factors should prompt careful consideration:

Age under 45: The majority of manipulation-related strokes occur in younger adults, suggesting this age group may be more vulnerable to dissection.

Smoking: Damages blood vessels and increases stroke risk in general.

Migraine history: Some research suggests people with migraines may be at slightly higher risk for dissection.

Recent infection or inflammatory condition: These can temporarily weaken arterial walls.

Dr. Sherief Elsayed emphasizes thorough screening before any neck treatment. “Every spine is different. Every treatment should be, too,” he reminds patients. “A proper history and examination should identify people at higher risk. If risk factors are present, safer treatment alternatives should be considered.”

What safer alternatives exist for treating neck pain in Dubai and the UAE?

The good news is that many effective treatments exist for neck pain that don’t involve high-velocity manipulation of the cervical spine. Dr. Sherief Elsayed’s approach prioritizes these safer options as first-line treatment.

Conservative treatments with excellent safety profiles:

Physiotherapy without manipulation: Skilled physiotherapists can treat neck pain using gentle mobilization, stretching, strengthening exercises, postural correction, and pain-relieving techniques like heat, ice, or electrical stimulation. These approaches improve function without the risks associated with high-velocity manipulation.

Postural and ergonomic modifications: Much neck pain in Dubai results from prolonged desk work, poor computer workstation setup, or smartphone use. Simple adjustments to your workspace, taking regular breaks, and improving posture can significantly reduce neck strain. Dr. Sherief Elsayed examines each patient’s work environment and daily habits, often finding modifiable factors contributing to pain.

Exercise and strengthening programs: Specific exercises that strengthen the deep neck flexor muscles and improve shoulder blade stability can reduce neck pain and prevent recurrence. These exercises are safe and can be performed at home once learned.

Pain medication: Over-the-counter anti-inflammatory drugs like ibuprofen can reduce pain and inflammation. For more severe pain, prescription medications including muscle relaxants or neuropathic pain medications may be appropriate. Dr. Sherief Elsayed prescribes medications as part of a comprehensive treatment plan, not as a standalone solution.

Injections: For certain types of neck pain, targeted injections can provide significant relief:

• Facet joint injections for pain from the small joints between vertebrae
• Trigger point injections for muscle-based pain
• Nerve root blocks for pain caused by pinched nerves
• These procedures are performed under image guidance for precision and safety

Heat and cold therapy: Simple but effective, these can reduce muscle spasm and inflammation.

Stress management and relaxation techniques: Many people carry stress in their neck and shoulder muscles. Techniques like mindfulness, breathing exercises, or yoga can reduce muscle tension.

Low-velocity mobilization: Gentle, oscillating movements of the neck joints can improve mobility and reduce pain without the sharp, twisting movements of traditional manipulation. This approach, often performed by osteopaths or physiotherapists, provides many benefits of manipulation with substantially lower risk.

Acupuncture: Some patients find relief with acupuncture, which has a good safety profile for neck pain.

Lifestyle modifications: Improving sleep quality, staying hydrated, managing stress, and maintaining general fitness all contribute to neck pain management.

When imaging and further assessment are needed:

If conservative treatment doesn’t provide relief, or if symptoms suggest nerve compression or structural problems, advanced imaging like MRI can identify the specific cause. Once the root cause is identified, targeted treatment becomes possible.

“We treat the person, not the scan,” Dr. Sherief Elsayed explains, “but understanding what’s causing your neck pain allows us to choose the most effective and safest treatment. Surgery is not the first step. It is the right step only when necessary.”

Surgical options for specific conditions:

When conservative treatments fail and imaging shows structural problems like herniated discs, spinal cord compression, or instability, surgical options may include:

Anterior cervical discectomy and fusion (ACDF): Removes a damaged disc pressing on nerves or the spinal cord and stabilizes the spine

Cervical disc replacement: Preserves motion while removing the pain source

Posterior decompression: Relieves pressure from behind when the spinal canal is narrowed

These procedures have high success rates when properly indicated and are performed thousands of times safely each year in Dubai and the UAE. Dr. Sherief Elsayed uses robot-assisted spine surgery technology for complex cases, providing enhanced precision.

Should I avoid chiropractors completely or can some treatments be safe?

This is not a black-and-white question. Chiropractic care encompasses many different techniques, and not all involve high-velocity neck manipulation.

Lower-risk chiropractic approaches:

Many chiropractors use gentler techniques that don’t involve forceful twisting of the neck. These may include:

Mobilization instead of manipulation: Slow, gentle movements of the neck joints rather than quick, forceful ones

Soft tissue techniques: Massage and muscle release without joint manipulation

Spinal manipulation of the thoracic or lumbar spine: These areas are much safer for manipulation than the neck

Exercise prescription and lifestyle advice: Evidence-based guidance on managing pain

Instrument-assisted techniques: Using specialized tools rather than high-velocity manual thrusts

If you choose to see a chiropractor, consider:

Ask about techniques: Before any treatment, ask specifically what techniques will be used. If high-velocity cervical manipulation is suggested, ask about alternatives.

Discuss your risk factors: Inform the practitioner about any vascular disease, connective tissue disorders, high blood pressure, or other risk factors.

Insist on screening: A responsible practitioner should take a thorough history and examine you before treatment, looking for contraindications.

Start conservative: Begin with gentler approaches before considering manipulation.

Trust your instincts: If something doesn’t feel right or you’re uncomfortable with a proposed treatment, it’s okay to decline.

Alternative practitioners who may help:

Physiotherapists: Focus on evidence-based manual therapy, exercise, and functional rehabilitation without high-risk manipulation

Osteopaths: Often use gentler techniques than traditional chiropractic manipulation

Sports medicine physicians: Can provide comprehensive assessment and multimodal treatment

Spine specialists: For complex or persistent problems, a spine surgeon in Dubai like Dr. Sherief Elsayed can provide definitive diagnosis and a full range of treatment options

“I don’t tell people never to see a chiropractor,” Dr. Sherief Elsayed clarifies. “What I do tell them is to be informed about the risks, insist on thorough screening, ask about gentler alternatives, and know when to seek medical assessment instead. For many people with neck pain, there are safer, equally effective options available.”

What should I do if I’m currently experiencing neck pain?

If you have neck pain, taking a systematic approach leads to the best outcomes while minimizing risks.

Initial self-care steps:

For mild to moderate neck pain without red flags:

Apply ice or heat: Ice for the first 48 hours if there was an injury, then heat to relax muscles

Maintain gentle activity: Avoid complete immobilization but don’t push through severe pain

Check your posture: Especially during work, driving, and smartphone use

Take breaks from repetitive positions: Set a timer to remind yourself to move every 30 minutes

Try over-the-counter pain relief: Following package directions and checking with a pharmacist if you have other medical conditions

Avoid extreme neck movements: No forceful twisting or extreme extension

When to seek professional assessment:

See a healthcare provider if:

• Pain persists beyond one to two weeks despite self-care
• Pain is severe or progressively worsening
• Pain radiates into your arm with numbness or weakness
• You have difficulty with normal activities
• You have a history of cancer, osteoporosis, or immune suppression
• You develop fever with neck pain
• You have any neurological symptoms

Red flags requiring immediate medical attention:

Go to the emergency department or call 998 if you experience:

• Sudden, severe headache unlike any you’ve had before
• Neck pain after significant trauma like a car accident
• Loss of balance or coordination
• Double vision or difficulty speaking
• Numbness or weakness in arms or legs
• Loss of bladder or bowel control
• Severe neck pain with fever and confusion (possible meningitis)

Dr. Sherief Elsayed’s assessment approach:

When patients come to Dr. Sherief Elsayed with neck pain, his evaluation includes:

Comprehensive history: Understanding when pain started, what makes it better or worse, associated symptoms, previous treatments, and relevant medical history

Physical examination: Checking posture, range of motion, strength, reflexes, and sensation, looking for specific patterns that indicate the pain source

Lifestyle and ergonomic assessment: Evaluating work setup, daily activities, and habits that might contribute

Risk factor identification: Screening for contraindications to certain treatments

Imaging when appropriate: MRI or CT if symptoms suggest structural problems

Shared decision-making: Discussing all reasonable treatment options with clear explanations of risks and benefits

“Pain is a symptom, not a diagnosis,” Dr. Sherief emphasizes. “Understanding the root cause of your neck pain is essential to choosing the most effective and safest treatment.”

Conclusion

Can neck chiropractic adjustments cause stroke? The answer is yes, they can, though the risk is low. Well-documented cases exist, and the mechanism involving vertebral artery dissection is well understood. While the absolute risk is small, perhaps 1 to 3 per 100,000 manipulations, the consequences can be catastrophic.

The more important question is: should this risk change how you approach neck pain treatment? Dr. Sherief Elsayed believes it should prompt careful consideration. Given that many safe, effective alternatives exist for treating neck pain, there’s little reason to accept even a small risk of stroke from high-velocity neck manipulation for most patients.

If you develop severe headache, neck pain, or neurological symptoms during or after neck manipulation, this is a medical emergency. Seek immediate care.

For people seeking neck pain relief in Dubai and the UAE, Dr. Sherief Elsayed recommends a systematic approach: proper diagnosis first, conservative treatment with low-risk options, and escalation to more invasive treatments only when clearly indicated. “Every spine is different. Every treatment should be, too,” he advises.

The goal is not to fear all neck treatment but to make informed choices that maximize benefit while minimizing risk. Your neck contains structures too vital to put at unnecessary risk when safer alternatives exist.