Could neck manipulation be associated with stroke?

Therapies that involve neck manipulation may be associated with strokes, a new scientific statement has revealed. 

The observation, which was published in the American Heart Association journal 'Stroke', claimed that while neck treatments may be linked with strokes, medical experts cannot be certain they cause the condition. 

Ischemic strokes can result from cervical artery dissections (CD), which are small tears in the neck's artery wall layers. Trivial or serious neck trauma leading to CD can cause blood clots that block the vessels in the brain. 

Dr Jose Miller, lead statement author and professor and chair of neurology at the Loyola University Chicago Stritch School of Medicine, stated that most CDs occur after stretching, mechanical stress or trauma. 

"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," he explained. 

As such, neck manipulation therapies that use manoeuvres where the neck is rotated or given a forceful thrust could cause damage. 

Dr Miller added that while a cause--and-effect relationship between these therapies and CD had not yet been established, CD could still result in neurological injury. He argued that patients must be told of this link before they undergo cervical manipulative treatments. 

The link between neck therapies and CD was recognised after case control studies, although these are not designed to establish cause and effect. 

According to the scientific statement, it is difficult to prove a causal relationship between the two because people often seek treatment when they develop neck pain. 

However, Dr Miller advised anyone experiencing neurological symptoms following neck manipulation, such as slurred speech or vomiting, to seek medical attention. 

"Some symptoms, such as dizziness or vertigo, are very common and can be due to minor conditions rather than stroke, but giving the information about recent neck manipulation can raise a red flag that you may have CD," he said.

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