The American Heart Association/American Stroke Association have released a scientific statement warning that neck manipulation is associated with cervical dissection, a type of arterial tear that can lead to stroke. Although a cause-and-effect relationship is far from being proved, the groups say that healthcare providers should tell their patients about the association before starting the procedure.

Cervical artery dissection (CD) is a small tear in the layers of artery walls in the neck. It can result in ischemic stroke if a blood clot forms after a trivial or major trauma in the neck and later causes blockage of a blood vessel in the brain. Cervical artery dissection is an important cause of stroke in young and middle-aged adults.

“Most dissections involve some trauma, stretch or mechanical stress,” said José Biller, M.D., lead statement author and professor and chair of neurology at the Loyola University Chicago Stritch School of Medicine. “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.”

Although techniques for cervical manipulative therapy vary, some maneuvers used as therapy by health practitioners also extend and rotate the neck and sometimes involve a forceful thrust.

“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,” Biller said. “Patients should be informed of this association before undergoing neck manipulation."