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Will An Osteopath Crack My Neck?

Updated: Jun 18, 2021


Osteopath manipulates a patients neck.
Neck cracking must be done safely.

The answer is possibly. Neck manipulation is a technique used by manual therapists to mobilise joints in your neck so they make an audible "pop" noise. There is a lot of confusion and mis-information out in the public domain about neck cracking, not least because it is called a different thing by each profession that uses it. The Chiropractors will suggest you have an adjustment. Physiotherapists will use a "Grade V joint mobilisation". If you see an Osteopath you will have a HVLA or a HVT performed on you- (Variously, a High-Velocity-Low-Amplitude technique or High-Velocity-Technique). Some General Practitioners also complete training in joint manipulation and will use it. And some will tell you to never let anyone touch your neck because you might die.


Now, while you can dismiss the last assertion as fear-mongering hyperbole, some caution in using this technique is definitely advised, as there have been cases where people have been injured after neck manipulation. These cases are rare, but need to be considered.


Best practice in most countries where the health professions are well regulated, like Australia, involve the use of an informed consent process to disclose known risks associated with treatment procedures. The same process is used before you have a surgical procedure. It's similar to the way side effects are listed on the back of medicine packaging.


Injuries and symptom exacerbations following neck manipulation are known as adverse events or complications. Here is what we know about complications following neck manipulation:


  • Both serious and non-serious complications of neck manipulation are recognised.

  • Non-serious complications are mostly relating to an aggravation of symptoms.

  • Serious complications are mostly reporting on vertebral artery (or more rarely carotid artery) dissection, and stroke which can develop following this.

  • Injuries to these arteries can potentially lead to brain damage and death.

  • Serious complications are rare.


Rates of serious complications can only be estimated because of the difficulties with establishing causation and with under reporting, but they are estimated to be between 1 in 50,000 and 1 in 5 million manipulation, with most research authors settling somewhere around the 1 per 1 million manipulations mark.


This is enough to cause concern and make us improve our practice to make sure we minimise the risk of injuring patients.


But there are a lot of unscrupulous practitioners out there who have their heads stuck in the sand about these risks, which is ethically unacceptable. Some therapists refuse to consider that neck manipulations can be a dangerous technique. Some do ridiculously high velocity thrusts using slings that I would never, ever have performed on myself or recommend. There are still lot of therapists whom use neck manipulations on a high frequency of patients that come through the door regardless of their complaint.


The research keeps developing. Since I started practicing almost 20 years ago, I have definitely reduced the number of neck manipulations I perform. But most weeks I will still use the technique once or twice on patients whom consent for sit to be done after discussing the risks. (I will also still have someone manipulate my neck when it is sore and stiff)


With my patients I am very selective about the application of cervical manipulation. I for the most part don't do them on anyone over 40 years old, where the risk of joint degenerative changes is increased. I don't use them on hypermobile patients. I don't use them on Migraine sufferers. And I don't use them on anyone with any increased risk of cardiovascular disease. But I still use them on people with a primarily stiff neck issue without any of the above symptoms or risk factors. I will use manipulation on people who fit the above criteria with acute neck pain. We know that neck manipulations are effective in improving range of motion in stiff, panful necks and reducing pain.






Sometimes I have to talk my patients out of the idea that they need to have their neck cracked- If I think they will be better served by a different approach. And sometimes I lose patients because I WONT crack their necks. Im OK with that. There are others practitioners who are more aggressive with their approach.


If you are seeking out neck treatment you should make sure the practitioner you see has an informed consent process where they discus the the risk of these techniques with you before treatment is applied, and you don't feel pressured into consenting to it. They should not do any manipulations before they have discussed this with you. Otherwise go elsewhere.


Call us at the clinics to get in touch with Eddie.


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