If you've ever considered seeing a chiropractor, you've probably heard it.
"Be careful."
"I heard someone had a stroke after getting their neck adjusted."
Sometimes it comes from a friend.
Sometimes it's a family member.
Sometimes it's even another healthcare provider.
It's a serious concern, and it's one that deserves a serious answer.
A stroke is not something anyone should dismiss. If there were strong scientific evidence showing chiropractic adjustments routinely caused strokes, I wouldn't perform them.
Fortunately, that's not what decades of research have found.
What concerns me is that most conversations about this topic stop after the headline.
Very few people are ever shown the actual research.
They're rarely given real numbers.
They're almost never told how uncommon these events are.
And almost nobody compares those risks to the alternatives being recommended instead.
That's the conversation I'd like to have with you.
Not based on fear.
Not based on opinion.
Based on evidence.
A quick note before we continue: Cervical artery dissection is a real and serious medical condition. If you experience sudden, severe neck pain, a sudden severe headache unlike anything you've had before, weakness, numbness, difficulty speaking, vision changes, dizziness, or any other signs of a stroke, seek emergency medical care immediately. This article discusses what the scientific research says about chiropractic care and stroke risk, but it should never replace prompt evaluation when emergency symptoms are present.
First, Let's Talk About What We're Actually Discussing
The concern surrounding chiropractic care and stroke centers on a condition called vertebrobasilar artery dissection.
A dissection is a tear within the wall of an artery supplying blood to the brain. In rare situations, that tear can lead to a stroke.
Over the years, chiropractic neck adjustments became associated with this condition in public conversation.
The problem is that association is not the same as causation.
Just because two events happen around the same time doesn't mean one caused the other.
That's why good research exists.
It allows scientists to test assumptions instead of accepting them.
And when researchers began studying this question on a population level, the results painted a very different picture than the one many people have heard.
What the Largest Population Studies Found
One of the most influential studies on this topic was published in Spine in 2008.
Researchers analyzed 818 cases of vertebrobasilar stroke across more than 100 million person-years of health records.
Their conclusion surprised many people.
Patients over age 45 showed no increased association between chiropractic visits and vertebrobasilar stroke compared with visits to primary care physicians.
Among younger patients, researchers noticed something interesting.
The same association appeared after visits to both chiropractors and medical doctors.
If chiropractic adjustments were causing strokes, you wouldn't expect to see the exact same pattern following visits to family physicians.
Instead, the researchers concluded something far more logical.
People experiencing the early stages of an arterial dissection often develop neck pain or headaches before the stroke occurs.
Naturally, they seek help.
Some visit their chiropractor.
Others visit their physician.
The developing dissection is what prompted the appointment.
The appointment didn't create the dissection.
That's an important distinction because it changes the entire conversation.
The best available population data suggests patients are seeking care because the dissection has already begun, not because treatment caused it.
The Numbers Most People Never Hear
Research becomes much easier to understand when we stop speaking in vague terms and start looking at actual numbers.
Over a ten-year period, chiropractors in Canada performed approximately 134.5 million cervical adjustments.
Across that entire decade, 23 vascular events were reported following chiropractic care.
That's where the often-quoted statistic comes from.
Approximately one event for every 5.85 million cervical adjustments.
Another way to think about it is one event per 8.06 million chiropractic office visits.
Researchers even calculated what that means over the course of a professional career.
Statistically, a chiropractor would need to practice for approximately 1,430 years to be associated with a single vascular event.
That doesn't mean the adjustment caused the event.
It simply reflects how extraordinarily uncommon these reports are.
More recent research continues moving in the same direction.
Two large studies published in 2022 and 2023 evaluated more than 345,000 patients and over 3.6 million spinal adjustments.
Across all of those patients and all of those treatments, researchers reported zero vascular injuries attributed to the spinal adjustments performed by trained practitioners.
What Biomechanics Tells Us
Population studies tell us what happened.
Biomechanics helps explain why.
This is one of the most fascinating parts of the research, and it's also one of the least discussed.
Dr. Walter Herzog and his team at the University of Calgary have spent years studying exactly what happens to the vertebral artery during a chiropractic neck adjustment.
Instead of relying on assumptions, they measured the mechanical forces involved.
Their findings were remarkably consistent.
The amount of strain placed on the vertebral artery during a properly performed chiropractic adjustment was less than the strain experienced during normal head movement and routine diagnostic testing.
Think about that for a moment.
Looking over your shoulder while backing your car out of the driveway.
Checking your blind spot.
Turning your head during everyday conversation.
According to the biomechanical measurements, those normal daily movements place as much or more mechanical stress on the vertebral artery than a chiropractic adjustment.
A follow-up study published in 2023 strengthened those findings even further.
Researchers found that the vertebral artery wasn't actually being stretched during cervical manipulation.
Instead, the artery simply took up its natural slack as the neck moved.
The measured forces remained well below the level required to mechanically damage the vessel.
That's a very different picture than the one many people imagine when they hear discussions about chiropractic and stroke.
These aren't opinions from a chiropractic organization.
They're measurements collected in a biomechanics laboratory using scientific instrumentation.
One Problem That Rarely Gets Mentioned
Another part of this story receives surprisingly little attention.
Researchers Alan Terrett and Adrian Wenban carefully reviewed published reports describing manipulation-related injuries.
What they discovered was concerning.
In numerous cases, injuries caused by individuals who were not chiropractors were still reported using the term "chiropractor."
Those cases included practitioners such as massage therapists, osteopaths, medical doctors, barbers, martial arts instructors, and even instances of self-manipulation.
In several reports, the original records correctly identified the provider.
Yet later publications still described the event as chiropractic care.
That distinction matters.
Scientific literature shapes public perception, physician recommendations, legal decisions, and healthcare policy.
Accuracy matters.
When practitioners without chiropractic training are repeatedly grouped together with licensed chiropractors, it becomes much more difficult for patients to understand what the research actually says.
Now Let's Talk About Ibuprofen
This is the comparison that almost never gets made.
And I believe it should be.
When patients tell me they're nervous about chiropractic care because they've heard it can cause a stroke, I often ask another question.
"What are you taking instead?"
More often than not, the answer is ibuprofen, Advil, Motrin, or another anti-inflammatory medication.
Here's what's interesting.
A large network meta-analysis published in the British Medical Journal evaluated the cardiovascular safety of several commonly used non-steroidal anti-inflammatory drugs (NSAIDs). Researchers analyzed 31 clinical trials, involving more than 116,000 patients and over 115,000 patient-years of follow-up.
Their findings were striking.
Ibuprofen was associated with a 236% increased risk of stroke compared with placebo.
Diclofenac, sold under brand names such as Voltaren, was associated with a 186% increased risk of stroke.
Rofecoxib (Vioxx) demonstrated a 112% increased risk of heart attack before ultimately being removed from the market.
I'm not sharing those numbers to scare anyone away from medication.
Every treatment has risks.
Every treatment also has potential benefits.
My point is much simpler.
If we're going to have honest conversations about risk, we should apply the same standard to every treatment option.
Chiropractic care has been scrutinized for decades.
Medication deserves the same level of scrutiny.
Patients deserve comparisons built on evidence rather than assumptions.
That's how informed healthcare decisions should be made.
What Does the Nobel Prize Have to Do With Chiropractic?
In 2021, the Nobel Prize in Physiology or Medicine was awarded to David Julius and Ardem Patapoutian for their groundbreaking work explaining how the human body senses touch, pressure, temperature, and mechanical movement.
At first glance, you might wonder what that has to do with chiropractic care.
Quite a bit.
Since chiropractic was founded in 1895, one of its central principles has been that normal joint movement and healthy nervous system function are closely connected.
Modern neuroscience has continued to expand our understanding of mechanoreceptors, proprioception, and the body's remarkable ability to detect movement and position.
The Nobel Prize wasn't awarded to validate chiropractic.
That's not what happened.
But it did recognize the importance of understanding how the body senses mechanical forces, something chiropractic researchers and clinicians have been studying for more than a century.
When people ask why restoring normal joint motion matters, this is part of the answer.
Movement isn't simply about flexibility.
Movement is neurological.
Every joint in your body constantly sends information to your brain.
Healthy movement contributes to healthy communication throughout the nervous system.
That's why chiropractors focus so heavily on restoring proper motion rather than simply chasing pain.
So What Does All of This Mean?
No healthcare intervention is completely free of risk.
Not chiropractic.
Not medication.
Not injections.
Not surgery.
Not even choosing to do nothing.
The question has never been whether risk exists.
The question is whether that risk is being communicated honestly and placed into proper context.
After decades of population research, biomechanical investigation, and clinical observation, the evidence paints a remarkably consistent picture.
The best available studies do not support the claim that properly performed chiropractic cervical adjustments cause strokes.
Instead, they suggest something much more likely.
Patients experiencing the earliest symptoms of an already developing vertebral artery dissection often seek care because of neck pain or headaches. Some choose a chiropractor. Others choose their primary care physician. The visit follows the condition, not the other way around.
The biomechanical evidence supports that conclusion.
The population studies support that conclusion.
The safety data continues to support that conclusion.
That doesn't mean chiropractors stop evaluating patients carefully.
Quite the opposite.
Every patient deserves a thorough history, a comprehensive examination, and thoughtful clinical judgment before treatment recommendations are ever made.
Safety begins long before an adjustment.
Frequently Asked Questions
Conclusion
If you've avoided chiropractic care because you've heard that neck adjustments cause strokes, I hope this article has encouraged you to look beyond the headlines and examine the evidence for yourself.
If you have questions about whether chiropractic care is appropriate for your specific condition, I'd be happy to sit down with you, review your health history, perform a thorough examination, and explain my recommendations. Every patient is different, and every treatment plan should reflect that.
If you're looking for a trusted chiropractor in Davie, my goal is simple: provide honest answers, evidence-based care, and recommendations that put your health and safety first.
One Standard. Applied to Everything.
Here's the challenge I'd leave you with.
The next time someone tells you chiropractic causes strokes, ask them to show you the research.
Ask for the actual numbers.
Ask what those numbers are being compared against.
Ask whether they've looked at the biomechanics.
Ask whether they've considered the difference between association and causation.
Then apply that exact same standard to every healthcare decision you make.
The medication sitting in your cabinet.
The procedure someone recommends.
The supplement advertised as "natural."
Every healthcare choice deserves the same level of honest scrutiny.
That's not being anti-chiropractic.
It's not being anti-medicine.
It's simply being an informed patient.
About the Author:
Dr. Zev Mellman is a licensed chiropractor serving patients throughout South Florida and beyond. His practice focuses on spinal health, mechanical causes of pain, and conservative approaches to musculoskeletal care.
- Licensed Doctor of Chiropractic in the State of Florida
- Florida License Number: CH9524
- License Original Issue Date: 01/15/2008
