Earlier this year, Danielle Belardo, MD, a preventive cardiologist at Precision Preventive Cardiology in Los Angeles, was going about her regular workday when a young stroke patient arrived. Dr. Belardo was surprised—the woman had been perfectly healthy and had no medical history that might suggest a stroke. But when she heard that the young woman had gone to her chiropractor for an adjustment earlier in the day, it all started to make sense.
The woman had experienced a Biffl grade II dissection of the vertebral artery, right on the chiropractor’s table, following a neck adjustment, says Dr. Belardo, who describes that as a “very high-grade dissection.” That arterial tear obstructed blood flow to her brain, causing a stroke. Immediately, she experienced vision changes, difficulty walking, and started to develop weakness on one side of her body.
Thankfully, the patient survived, but she is still working to regain full function in the body parts affected by the stroke and has to take medications to prevent new clots. Dr. Belardo is hopeful that, with physical therapy and rehab, the young woman will make a full recovery—but the doctor was completely heartbroken by her patient’s experience. The story stuck with her because this wasn’t the first time she’d seen someone have a stroke after a neck adjustment at the chiropractor. She’d seen three other patients like this in her career. “I felt tremendous guilt that I didn’t write up the first three cases,” she says.
Springing Into Action
This time, Dr. Belardo took a different path.
After asking the patient if she could write up her case to submit to a medical journal (the patient quickly agreed), Dr. Belardo posted the story and her thoughts on X and Instagram. “Heartbroken after seeing a young patient with no medical history end up with a BIFFL GRADE II dissection of the vertebral artery and subsequent acute PICA infarct immediately after a neck adjustment from the chiropractor. This has to stop,” she wrote. “How can we live in a world where it’s legal to perform something with zero evidence for benefit (neck adjustment from a chiro) when there are such incredibly dangerous and life changing risks?”
That post on X from September 24 has been viewed 5.6 million times, has been shared 8,800 times, and has 1,800 comments on it—mostly from other doctors and people who have a personal story about a neck manipulation gone wrong.
“You’ll see countless physicians in every specialty, in every state, that see this. You’ll see vascular radiologists who see this 10 times a year,” Dr. Belardo says of strokes associated with neck manipulation. “You’ll have neurologists who are neuro intensivists who say, ‘We see this all the time.’”
Neck Manipulation Breakdown
A neck, or cervical, manipulation is a procedure done at a chiropractor’s office that involves “adjusting” the upper vertebrae of the spine to alleviate muscle tension, pain, or headaches. Usually it involves a high-velocity thrust to adjust your neck, rotating and stretching it to create that popping noise that keeps us enthralled on TikTok and Instagram. The American Chiropractic Association, in an email to Women’s Health, calls it “a safe and effective non-drug treatment for common forms of neck pain and headache.”
Many medical doctors, on the other hand, say studies show that neck manipulation does not have any long-term benefits or yield the same results for the patient as other treatments, like physical therapy (Dr. Belardo claims its benefits are akin to those of rubbing your own neck), so it’s not worth the risk of stroke.
Most of the time, a neck adjustment is not dangerous. (The doctors we spoke to for this article all agreed that strokes are a very rare occurrence.) But sometimes, according to these doctors, the fast movement of the neck during the adjustment can damage the cerebral arteries—which include the vertebral arteries—at the back of your spine. These arteries have the essential job of bringing blood to your brain, and the doctors we spoke to also say that any tears or “dissections” can result in stroke, either immediately or up to 31 days after symptoms appear.
“There is no stroke neurologist who doesn’t cry after going home because of all of the devastating cases they see,” says Ayesha Sherzai, MD, a neurologist and cofounder of the Brain Health Institute, speaking generally about stroke patients. “[It] truly takes away everything from a person’s life within seconds and minutes. It’s pretty devastating.”
Dr. Sherzai estimates she’s seen about five neck manipulation–associated stroke cases since she started her fellowship in vascular neurology in 2013. She distinctly remembers two patients—a 36-year-old mother of two who came to the emergency room after vomiting, losing vision, and falling to the floor post-adjustment, and another patient in her 40s who actually died after experiencing a hemispheric stroke (a stroke affecting a full half of your brain). “It is very, very sad,” she says. In her opinion, “it is very likely due to the chiropractic manipulation.”
The vertebral arteries in the back of your neck are “so, so, so thin, and they’re so tenuous,” per Dr. Sherzai. When the neck is adjusted, the artery’s lining can tear and create a flap that blocks blood flow to the brain. “If the brain doesn’t get oxygen or blood, even for seconds, millions and millions of arteries tend to die,” she says. That lack of blood and oxygen to the brain is what results in a stroke.
John Parente, MD, chief of emergency medicine at a hospital in northeast Ohio, has seen at least two or three of these injuries in his career. He recalls a recent patient—another young woman—who had her neck adjusted, vomited immediately, and experienced a stroke. While Dr. Parente has gone to the chiropractor himself and thinks there’s value in visiting one for back pain, he draws a line at neck manipulation.
“I tell all my family members, if you go to a chiropractor, tell them they can do anything they want, but stay away from the neck as far as that particular maneuver,” he says. “There could be some potential upside here. But what’s the downside? The downside is [possible] permanent disability, stroke, death, loss of vision.”
The American Chiropractic Association disagrees with the MDs who say the data suggests an association between neck manipulation and strokes. “The chiropractic profession relies on the largest and most credible research studies on this topic to date, which have not found a causal relationship between neck manipulation and arterial dissection leading to stroke.… Millions of neck manipulations are performed safely, providing pain relief and helping patients get back to their normal activities,” the organization wrote in a statement to Women’s Health.
Some chiros will defend the practice by suggesting that patients who have a stroke after neck manipulation were likely already experiencing pain related to an artery dissection, which is simply exacerbated by the adjustment.
Dr. Sherzai believes this line of thinking is “absurd.” Pain caused by a dissection is “not something that people tend to have for days or weeks or months—that doesn’t happen,” she says.
Experts like Dr. Belardo, who have repeatedly seen these injuries in their careers, say they want more data to better understand what’s going on. Yes, these dissections and strokes are a rare injury, but they still happen. And the lack of precise data does not make that risk less serious—it amplifies it, she says.
“I believe that this is an archaic way of getting rid of pain, and it should be discontinued as soon as possible,” says Dr. Sherzai. “With better imaging, stringent processes of documenting the factors, adjusting for them in research, I think we’ll be able to present a clear case of how this relationship [between stroke and neck manipulation] exists.”
A Call To Find The Data
Inspired by SCAD registries—created to log heart attacks caused by spontaneous coronary artery dissection, which primarily affect healthy women in their 40s and 50s—Dr. Belardo and Dr. Sherzai are calling for a registry to track these incidents, and hope other physicians will contribute to it. Currently, there is no mandatory registry for vertebral artery dissections or carotid dissections, Dr. Belardo says. “We have no idea if the risk is one in 1,000 or one in 100,000.”
After their call to action and the massive response it received online, Dr. Sherzai recognized what an amazing opportunity this was to start documenting cases. “There is a dire need for a registry,” she says. “We’re reaching out to different neurologists and different bodies of medicine, whether it’s the American Heart Association, American Stroke Association, the American College of Lifestyle Medicine—even some really nice evidence-based chiropractic doctors are willing to work with us.”
The hope? Gather better data to determine if there’s a causal relationship and, if so, publish new medical guidelines for doctors and chiropractors on the risks of neck manipulation.
Dr. Parente thinks a registry is a great idea. “When bad things happen to people, we tend to just do our best to treat them and get them pointed in the right direction, whether that be a surgery or a specialist, and then we go on to the next patient. There’s very little conversation or infrastructure to say, ‘Okay, how do we prevent this from happening again?’” he says. “It’s really hard to get this data.”
In the meantime, it’s important for chiropractic patients to have a discussion with their practitioner before any neck adjustment, to make sure they know what the risk is and can decide for themselves whether they’re willing to take that risk. “You can have informed consent and an informed discussion,” says Sareh Rajaee, MD, a vascular surgeon based in New York. For Dr. Parente’s part, while he believes that chiropractors have a place in the health-care landscape, he reiterates that people should avoid neck adjustments because there’s “just too much risk.”
Currie Engel is the news and features editor at Women’s Health. She loves working on zeitgeisty news, culture, mental health, and reproductive rights stories. When she’s not editing stories, she’s writing them. Currie previously worked as an award-winning local reporter specializing in health investigations and features, and as a researcher at Time magazine.
