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Neck Cracking and Stroke: How Risky Is It?

man stretching his neck

May 20, 2019 -- The story about the 28-year-old Oklahoma man who had a stroke after stretching his sore neck has gone viral recently, and now, thankfully, a happy ending is in sight.

Josh Hader, a husband and father of two, says he is walking better now, and his vision is getting back to normal, too. He's hoping to get back to his full-time work as an account manager at a computer company later this month and put the ordeal that began March 14 behind him.

His experience has fueled an important discussion about neck cracking or stretching: Is it safe, or can it hurt you?

Neck Cracking: Relief or Risky?

The link between neck cracking and stroke does exist, at least for some, neurologists say. "In general, you can't generate enough force or movement on your own to cause a tear of the blood vessel, which ultimately is what probably causes the stroke," says Doojin Kim, MD, co-medical director of the stroke program at UCLA Medical Center in Santa Monica, CA. He did not treat Hader but spoke in general about neck cracking. He says that ''in some, their genetics may make their blood vessels a little more fragile or their connective tissue a little more pliable. So, in general, I recommend patients don't do it."

"The risk of cracking is not entirely understood," says Steven Messe, MD, associate professor of neurology at the University of Pennsylvania Perelman School of Medicine in Philadelphia, who also spoke in generalities. ''The vertebral arteries run into the bones of the spinal column of the neck," he says, and ''you can potentially end up blocking that artery when you crack your neck."

Messe tells people to avoid neck cracking if possible, ''because there may be a small risk'' of a dissection, or tear in the lining of an artery.

However, Keith Overland, DC, who has a chiropractic practice in Norwalk, CT, and is a past president of the American Chiropractic Association, says that if neck cracking is done very rarely, ''It's not bad." But people should not make a habit of it.

But Overland acknowledges that ''it becomes a habit'' for some, and they crack their neck multiple times a day.

And some people may have a condition or a genetic weakness, he agrees, and the cracking could strain the neck too much.

Professional Neck Manipulation: Safe or Risky?

So much for do-it-yourself neck cracking. What about the cervical manipulative therapy, or CMT, done by chiropractors, osteopaths, and physical therapists? It involves applying a thrust to the neck and cervical spine. In a scientific statement issued in 2014, the American Heart Association-American Stroke Association concluded that moving the neck in this way has been linked with cervical dissection, a tear in the artery that can lead to a blood clot and a stroke.

A direct cause-and-effect link has not been established, but the Heart Association-Stroke Association statement recommends that health care providers tell patients of the risk before they have neck manipulation.

In response, Overland cites a study in which researchers looked at the force applied during spinal manipulation, working on cadavers, and found the strain unlikely to damage the artery.    

Patients who have a stroke after having their neck manipulated may already have been at risk for stroke, Overland says. The therapy can help neck issues in carefully selected patients, he says, but he would not do it on a patient who already had visual disturbances, severe headaches, or sudden dizziness.

Josh Hader's Story

Hader is giving up neck stretching. If his neck is sore, he won't touch it. He didn't twist his neck at all before his stroke happened, he says, just stretched it a bit to relieve soreness after hours of working at the computer. "I tried to put my right ear to my right shoulder and applied a little pressure with my hand," he says.

That's when he heard a pop, and everything went wrong. "My whole left side started to go numb," he remembers. "I used to be a police officer, so I knew it could be a stroke."

He went to the kitchen to get an ice pack, but he was walking at a 45-degree angle. He called his wife, Rebecca, who wasn't at home. She called his father-in-law, who loaded him into a car and got him to the nearby ER quickly.

There, doctors confirmed it was a stroke, gave him the clot-buster drug called tPA (tissue plasminogen activator), and transferred him to a larger hospital in Oklahoma City. His stay included time in the intensive care unit; after that, he went to an inpatient rehab facility for another week and a half. Now he's graduated to outpatient physical therapy.

He still has some ''tingly'' feelings in his left side, he says. He decided to speak out during May, National Stroke Awareness Month, to highlight the risks of a habit that many people view as harmless, he says.

WebMD Health News Reviewed by Hansa D. Bhargava, MD on May 20, 2019

Sources

Josh Hader, account manager, computer company, Guthrie, OK.

Keith Overland, DC, chiropractor, Norwalk, CT; past president, American Chiropractic Association.

Doojin Kim, MD, co-medical director, stroke program, UCLA Medical Center, Santa Monica, CA.

Steven Messe, MD, associate professor of neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia; fellow, American Academy of Neurology.

American Heart Association/American Stroke Association scientific statement: “Cervical Arterial Dissections and Association with Cervical Manipulative Therapy,” October 2014

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