Large Study Finds No Added Risk of Rare Artery Tear Following Chiropractic Neck Care

CLEVELAND - Getting your neck adjusted by a chiropractor does not appear to raise the risk of a rare but serious artery injury, according to a large observational study from a multidisciplinary collaboration including researchers at University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland Clinic, and Duke University.

The study, published in Chiropractic & Manual Therapies, examined the association between chiropractor-administered spinal manipulation and cervical artery dissection, a relatively rare condition involving a tear in a neck artery that can lead to stroke. Analyzing data from more than 862,000 adults who sought care for a new episode of neck pain or headache, the study found no evidence of increased risk of cervical artery dissection among patients receiving chiropractor-administered cervical spinal manipulation compared with those prescribed ibuprofen.

Researchers analyzed health records and insurance claims from a United States database covering patients treated between 2010 and 2025. After excluding anyone with a prior history of cervical artery dissection or related conditions, they used statistical matching to build two comparable groups of more than 431,000 patients each: one that received chiropractic neck manipulation, and one that instead received an ibuprofen prescription for their neck pain or headache. By matching the groups and balancing factors like age, sex, and other health conditions, researchers could rigorously compare outcomes between the two care approaches. In the final analytic sample, 31 patients in the chiropractic group and 58 patients in the ibuprofen cohort were diagnosed with a new cervical artery dissection within 30 days of follow-up.

"To address this complex clinical question, we formed a multidisciplinary collaboration, including authors representing chiropractic, cardiology, neurosurgery, physical therapy, orthopedic surgery, and biostatistics, and developed and registered a formal research protocol, making this one of the most methodologically rigorous studies on the topic to date" said Robert Trager, DC, lead author and Buoncore Family Endowed Director of Chiropractic Medicine at University Hospitals Connor Whole Health.

"People often ask me whether chiropractic care for neck pain is safe," said Christine Goertz, DC, PhD, co-author and researcher at the Duke Clinical Research Institute. "This study is some of the best evidence yet that the answer to that question is yes."

Several reasons make studying this question harder than it sounds. First, cervical artery dissection is a rare event, making it impractical to study using a randomized clinical trial. Second, benign neck pain and headache are common reasons to seek chiropractic care, but they can also be early warning signs of an undiagnosed artery tear. Together, these factors make it difficult to evaluate causation. Because this latter bias was well established in prior studies, the research team took several steps to mitigate it, principally by restricting the study to adults seeking care for a new episode of neck pain or headache.

Overall, these study findings are reassuring regarding the safety of cervical spinal manipulation. However, the researchers emphasized the importance of awareness of cervical artery dissection among patients with new episodes of neck pain or headache overall, noting that all clinicians, including chiropractors, physicians, and physical therapists alike, should be alert to warning signs such as sudden or unusual headache, neck pain unlike a patient's typical pattern, or neurological symptoms.

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REFERENCE

Trager RJ, Baumann AN, Labak CM, Lewis KL, Perez JA, Goertz CM, Schuster A: Association between spinal manipulative therapy and cervical artery dissection in patients with neck pain or headache: a retrospective cohort study. Chiropr Man Ther. 2026, 34:53. 10.1186/s12998-026-00678-4

The project was supported by the Clinical and Translational Science Collaborative of Northern Ohio, which is funded by the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Science Award grant, UM1TR004528. The work conducted by Robert Trager received support from the Elisabeth Severance Prentiss Foundation (Cleveland, OH) through general funding. The study did not receive a specific grant; no funder played a role in developing the study protocol or in any key decision-making.