Cracking of the Neck…[YIPES]


Understand the line of reasoning.

Patient: My neck hurts. Sometimes I have headaches or numbness down my arm.

Healthcareperson: Well sit down here so I can crank your neck  as far as it will go, every which way. Yeah. No. Seriously.

— 2 weeks  and 4 “treatments” later —

Patient: It feels a little better but not for very long. I’m still hurting.

Healthcareperson: You need maintenance adjustments.


Neck adjustments (manipulations or “cracking”) can cause major, even life-threatening injury. Are you aware of VAD stroke? Here is the first portion from Wikipedia:

Vertebral artery dissection (abbreviated VAD) is a dissection (a flap-like tear) of the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. After the tear, blood enters the arterial wall and forms a blood clot, thickening the artery wall and often impeding blood flow. The symptoms of vertebral artery dissection include head and neck pain and intermittent or permanent stroke symptoms such as difficulty speaking, impaired coordination and visual loss. VAD may occur after physical trauma to the neck, such as a blunt injury (e.g. traffic collision), strangulation or manipulation,

Did you notice that they include manipulation as a physical trauma to the neck?

While the occasion of severe injury or death due to forceful neck manipulation is relatively rare, it can and does happen.

But what most definitely  is NOT rare, is hearing clients in my office describe how indiscriminate cracking of their neck has made their neck pain, headaches, and arm pain/numbness much worse. Is this cranking on the cervical spine helpful or necessary? The clear answer is “No.”

[I was going to put a youtube link to cervical manipulation. But these days, there are no simple neck cracking videos. Now there are entire compilations of the shenanigans, literally volumes of 8- to 10-minute videos of nothing but ridiculous and mostly unhelpful neck cracking. Go find them if you like.]

Physical therapists often apply mobilizing forces to the neck and upper back. The vertebrae may or may not crack. But cracking is not magical and it’s not the end-goal. And before even gentle neck manipulation, the patient undergoes an evaluative process that includes”pre-manipulative” testing. This takes more than a few minutes, but easily allows us to determine whether or not a manipulation is safe and even necessary.


1. You should have underwent a thorough medical history and physical examination. This typically involves a series of tests that gently stress the neck in order to determine how your body respond to various mechanical forces.

2. If neck manipulation is warranted, the professional should do so with the MINIMAL force necessary to provide the desired outcome. This typically involves a common-sense application of gentle to moderate forces prior to forceful thrusts and “adjustments.” This is common sense from the standpoint of effective treatment with less risk of injury or pain exacerbation.

**With a gentle and systematic approach, we often find that the heavy-handed cracking is not necessary. You may realize that a little neck traction and -targeted- stretching get the job done just fine, and without long-term reliance on the healthcare provider.

3. Keep in mind that neck adjustments whether gentle or forceful, are far from a cure-all. In fact, your problem could be coming from segments of the neck moving too much (rather than too little), and all the forceful movement will only make the problem worse. In fact, this is 90% of people in all the neck manipulation videos. Just by looking at them, it is easy to tell that the problem is the moving too much with poor alignment, not from moving too little.  To get better and remain better, you may need more strength/stability or flexibility in specific areas involving the shoulders and spine.

4. Independence is the goal! Although most problems require some time to improve, nobody should have to rely on the healthcare professional for regular, long-term neck manipulations. Again, needing repeated adjustments is good evidence that the adjustments are not addressing the problem in the first place.

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