The American Heart Association have published a statement in which they say there may be an association between stroke and therapy involving neck manipulation, although they are unable to confirm whether neck manipulation causes stroke or not.

This continues a debate that has been ongoing in recent years, in which various experts have argued over the merits and shortcomings of neck manipulation within therapy.

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Ischemic strokes are the most common form of stroke, occurring when arteries connected to the brain become narrowed or blocked.

Two years ago, Medical News Today reported on a debate about the effectiveness of spinal manipulation published on In this debate, the benefits of the treatment were discussed, along with the possibility of neck manipulation being linked to stroke.

Neck manipulation has been associated with a risk of cervical artery dissection, a form of arterial tear that is believed to be an important cause of stroke in young and middle-aged adults.

The new statement from the American Heart Association (AHA) has been published in their journal Stroke, and they believe that patients should be informed of this potential risk prior to receiving neck manipulation therapy.

A cervical artery dissection (CD) is a small tear in the layers of walls in the arteries in the neck. If the tear becomes dislodged into the bloodstream, it can form a clot and cause an ischemic stroke by blocking one of the blood vessels in the brain.

Dr. José Biller, lead author of the statement, explains how these dissections can occur:

Most dissections involve some trauma, stretch or mechanical stress. Sudden movements that can hyperextend or rotate the neck – such as whiplash, certain sports movements, or even violent coughing or vomiting – can result in CD, even if they are deemed inconsequential by the patient.”

Some of the techniques used within neck manipulation therapy enact these sudden movements, by extending and rotating the neck and at times involving forceful thrusting.

The relationship between CD and neck manipulation therapies came to light after case control studies were carried out. However, these investigations are not designed to prove any cause and effect. As a result, it is unclear whether there are other factors involved that could explain the link.

“Although a cause-and-effect relationship between these therapies and CD has not been established and the risk is probably low, CD can result in serious neurological injury,” said Dr. Biller. “Patients should be informed of this association before undergoing neck manipulation.”

One reason the relationship between CD and neck manipulation is tricky to evaluate is that one of the symptoms of CD is neck pain, which can precede a stroke by several days. This neck pain may lead people to seek treatment such as neck manipulation in order to relieve their symptoms.

The AHA recommend seeking medical evaluation urgently if neurological symptoms develop following either neck manipulation or trauma. Such symptoms include the following:

  • Dizziness or vertigo
  • Double vision
  • Erratic eye movements
  • Nausea and vomiting
  • Pains in the neck or head
  • Slurring of speech
  • Unsteadiness.

“Some symptoms, such as dizziness or vertigo, are very common and can be due to minor conditions rather than stroke,” says Biller, “but giving the information about recent neck manipulation can raise a red flag that you may have a CD rather than a less serious problem, particularly in the presence of neck pain.”

Recently, Medical News Today reported on the development of “Strokefinder,” a helmet that can make rapid stroke diagnoses.