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Okay, now let that shoulder just drop in there,” the chiropractor says in the Instagram reel — one among many that show up in my feed. He stands on a pedestal that puts his thigh at the patient’s shoulder, holding the latter’s head in the crook of his elbow. You know it’s coming and then it does: a startlingly rapid movement of the head accompanied by an equally startling crack. (As in many of these videos, a tiny mic on the patient’s collar captures the auditory money shot.) The chiropractor has just performed a cervical adjustment. This time, the patient freezes, smiling, but other times, they gasp, or groan, or sputter, or curse, or gently protest, or, curiously, laugh. There’s often visible shock in their expression, even a momentary prickle of alarm. The theory behind cervical adjustments is that the soft tissues that hold your neck’s vertebrae in their proper place can move due to injury or poor posture or repetitive motion, aggravating the nerves that surround them. Improve joint motion in the neck with one swift crack, and you can ostensibly remove the pain. Many of the freshly cracked crow about the relief they feel. Twenty-nine percent of those who see a chiropractor call their treatment “very effective,” while another 38 percent find it “somewhat effective.” ”That’s the one I came for,” says the patient in that reel.
Watching relief flood a patient’s face, it’s hard not to feel jealous. For those of us who habitually stare downward at phones or frontwards at computers, neck pain has become a fact of life — one study on “forward head posture” (you may know it as “tech neck”) found that as many as 86 percent of Americans are living with a pain in the neck. What could be more enticing than an instant, dramatic cure? Though it’s impossible to say how many of the 35 million chiropractic adjustments Americans receive each year target the neck, each of the chiropractors I spoke to say that cervical adjustments constitute a significant portion of their practice, which is increasingly covered by insurers like Cigna, Aetna, and some Medicare and Medicaid plans. Americans and Canadians now visit chiropractors twice as often as they did 15 or 20 years ago.
Chiropractic, as the field is known, has gone mainstream in lockstep with the rise of social media. It makes sense, given that a sizable subset of those who use these platforms accept out-there wellness advice with a decidedly low-judgment, high-credulity mind-set and have a seemingly endless appetite for vicariously “satisfying” health content. (Think pimple-popping videos.) The online hive mind also has a lust for modalities outside the realm of conventional medicine — an ethos that lives a hop, skip, and a refused vaccine away from full-on distrust of conventional medicine.
This may be why millions of people, both online and off, blithely ignore the physicians who openly and loudly call chiropractic neck-cracking a dangerous menace — one that can ultimately be fatal.
Your neck is where your vertebral arteries, traveling through the cervical spine, assist the internal carotid arteries in the vital work of sending blood to your brain. It’s also the locus of numerous nerves, necessary for everything from transmitting sensory input to moving your arms. Yet unlike with, say, your brain, the neck’s tender innards aren’t protected by a bony shell. That makes the area a perfect storm of conditions for ruinous injury: It’s both hugely important and relatively vulnerable.
Last fall, a tweet by Los Angeles cardiologist Danielle Belardo, M.D., illustrated the stakes involved: “Heartbroken after seeing a young patient with no medical history end up with a BIFFL GRADE II dissection of the vertebral artery and subsequent acute PICA infarct immediately after a neck adjustment from the chiropractor. This has to stop. Chiropractors — you HAVE to stop.” Translation: The neck adjustment caused a tear in the tissue lining of the patient’s vertebral artery, known as a vertebral-artery dissection. This tear impeded their blood flow so severely that it cut off a portion of their brain from oxygen. In other words, the person had their neck adjusted and then they had a stroke.
It wasn’t a fluke. In 2016, 34-year-old Playboy model Katie May received a cervical adjustment, then suffered a fatal stroke; the Los Angeles County coroner determined her death was caused by the chiropractic visit. In 2022, 28-year-old Georgia resident Caitlin Jensen reportedly suffered a VAD and stroke after a neck adjustment. Her eyes turned inward, her vision was severely compromised, and she lost the ability to walk. And last year, a 40-year-old Missouri woman, Ashley Nelson, went to a chiropractor to cure a plane-ride-induced neckache. After her manipulation, she told a local news outlet, her “vision was completely crossed” and her face went numb. She learned at the hospital that a VAD had torn her artery, causing a clot which traveled to her brain and caused a stroke. A 2021 study in the journal Stroke estimates that 1 in 20,000 chiropractic neck adjustments results in an injury to vertebral arteries. While arterial dissection is not the only injury associated with chiropractic adjustments — some have experienced herniated discs and even vertebral fractures — it’s among the most devastating, and it’s almost certainly the one that triggers the most debate.
James Lehman is a chiropractic orthopedist and the director of the health-sciences postgraduate-education department at the University of Bridgeport in Bridgeport, Connecticut. He’s a neck-adjustment defender. “Statistically, if you had 57 chiropractors do a hundred cervical manipulations a week for 52 weeks for 20 years, one out of those 57 would encounter this situation,” meaning an arterial dissection and subsequent stroke, he tells me. “With that said,” Lehman continues, “a terrible adverse reaction is not acceptable if it could’ve been avoided.” He says that arterial dissections can be prevented via rigorous clinical examinations and thorough patient histories, and that the malpractice cases he’s consulted on have by and large involved chiropractors who failed to do this due diligence. If a chiropractor asks just a few basic medical questions —”Have you recently had an upper respiratory infection? Are you taking an antibiotic? Do you have a connective tissue disorder, like Ehlers-Danlos Syndrome or Marfan Syndrome?” — they can avoid a potentially deadly adjustment and refer the patient to a physician instead. Lehman also told me that “if a person complains of neck pain and headache, if you can’t reproduce that pain with your physical exam and then figure out how to make it better, you don’t really know what’s wrong with that patient. That means manipulation is contraindicated and you cannot proceed.”
Everything he said felt sensible. These injuries, however devastating, are rare. There’s a spectrum of quality when it comes to chiros — some run practices “like an assembly line,” Lehman said, spending no more than 90 seconds with a patient. But if someone chooses a good one, maybe they stand a better chance of avoiding injury. Lehman had also stressed the importance of informed consent, which is not, as he put it, just signing a piece of paper. “The most important thing is the dialogue between the doctor and the patient, explaining what’s wrong and how the treatment works,” he said. The gulf between a cautious practitioner like Lehman and TikTok’s legions of spine-yankers suddenly feels vast.
But when I speak with chiropractor William Lauretti, D.C., a spokesperson for the American Chiropractic Association, I quickly learn that what Lehman has told me is far from the consensus in the chiropractic community. “I’m pretty convinced that there is no clear evidence that a chiropractic treatment can cause a stroke on an otherwise healthy artery,” Lauretti says. He tells me that the stories of chiropractic-associated arterial dissections are sensationalized and that a chiropractor simply isn’t capable of that kind of damage. “Our signature treatment is what we call a high velocity, low amplitude spinal adjustment. We’re taking joints with limited motion and we’re applying a very quick but very shallow push to the joint to move it through its normal range of motion.” For this reason, Lauretti says, it’s impossible to gravely damage a vertebral artery — the force being applied just isn’t strong enough. “If a healthy patient comes into our office, there is literally no physical way we could create an arterial dissection,” he explains. “You see people get in car accidents, they get ejected through the windshield and their head hits a tree. They have a broken neck, and they die. But the vertebral artery is just fine. This is not some wimpy artery that blows if you turn your head. It’s robust by design.” However, that 2021 study in Stroke contradicts Lauretti’s assertions; it states that “VAD can result from trauma of varying severities,” mentioning sports, car accidents and even coughing and sneezing as potential culprits.
I ask Lauretti how a chiropractor can tell if a patient has an already-dissected cervical artery or is at risk of one. Lehman had been confident an exam and interview could uncover any existing risk factors, but Lauretti is far less sure. “It’s difficult,” he says. “Some people have had various imaging done — MRIs, ultrasounds — and the blood flow has been normal right up until they had a stroke. It’s an exceptionally difficult condition to diagnose in advance.”
Looking for consensus around the procedure’s safety, I call Steven Brown, D.C., a chiropractor in Gilbert, Arizona, who often serves as an expert witness in chiropractic malpractice cases. (When I ask him about the theatrical online crackings, he grimly replies, “Yes, I’ve seen many of those videos. Some of those people are the defendants in my cases.”) Brown seems not to find the stories of chiropractic injury to be overblown — indeed, he complained via email about the major chiropractic news outlets that, as he put it, “routinely ignore this issue.” He wants more chiropractors to be held accountable, to be made to see the dire results of failing to adequately examine their patients. But he’s firm on one point: Chiropractors don’t cause arteries to tear. They simply fail to see arterial injuries that already exist.
He tells me that in all the cases he’s reviewed, had the chiropractor slowed down, completed a better examination, and erred on the side of caution, the result would have been different. Bown says nausea is a red flag — if a patient has a dissected artery, they are likely in a great deal of pain, and persistent pain can cause nausea. Duration of pain is another strong indicator of VAD. “If somebody walks in with unilateral neck pain causing a headache on the same side that is very severe and it’s been there longer than 72 hours, that’s a red flag — most migraines and headaches go away after about three days.”
Brown sends me a case study he wrote for the July 2025 issue of Forensic Science International. He indicates in his email that the deceased subject, who is not named in the paper, is Katie May, the Playboy model who died in 2016 after a VAD and stroke. In the case study, Brown writes, “She reported a five-day history of sudden onset, worsening, severe, constant, dull, left suboccipital neck pain and left occipital headache. Pain level 8/10. She also reported nausea. Symptoms were not relieved by anything and affected all her daily activities … The chiropractor documented that her symptoms began with a neck injury five days earlier on a … photo shoot. Symptoms occurred when the photographer asked her to hold a pose for a long time that involved arching her back and leaning her neck to the side.”
Brown concludes in the study that the Los Angeles County coroner was wrong about the chiropractor causing May’s fatal injury — it was, in his view, likely that May was injured before her appointment, her VAD occurring as she held that awkward pose at the shoot. If May was already injured at the time of her chiropractic appointment, the adjustment she received would have been contraindicated. But it was performed anyway. “This clinical failure of DCs to recognize patients presenting with neck pain and headache from dissections is the heart of the issue,” Brown said in the email he sent with the case study.
The study finds that because seven-plus hours elapsed between May’s cervical adjustment and her stroke, it’s unlikely that the chiropractor’s manipulation was the cause of that stroke. In Brown’s opinion, the chiropractor’s responsibility for May’s death is tied to their failure to refer her to emergency services. In other words, the chiropractor had not caused May’s injury but had contributed to her death.
But I can’t help feeling that this is a distinction without a difference. If a patient must worry that their chiropractor might not spot an issue this concerning, why should they put themselves in a chiropractor’s care? And if a chiropractor can’t be entirely sure, how can they ethically proceed with an adjustment, given the potentially devastating consequences?
Orthopedic surgeon Chris Raynor, who has investigated chiropractic care for his YouTube channel, had this answer: There’s no ethical way to perform a cervical adjustment. He tells me that adjustments to the cervical spine are simply not worth the danger. “The incidence of injury is low,” he says. “But the injuries that can occur are catastrophic.” He points out that it doesn’t matter if chiropractors can detect arterial injury or not. “Either they can’t tell if an arterial injury is present, in which case they shouldn’t be taking the chance, or they can tell, which is worse because it means these injuries occur because patients aren’t being assessed appropriately.”
To Raynor, it all comes down to a cost-benefit analysis. “If studies show that exercise and physiotherapy and physical therapy are equally effective as chiropractic but come with no risk,” he asks, “why would you choose the riskier option?” And indeed, they do: A report published in Spine states that “no differences were detected in health improvement, costs, or recurrence rate between” subjects who saw a chiropractor and those who saw a physiotherapist.
The physicians I interviewed weren’t against all forms of chiropractic care. “I think chiropractors can be a reasonable non-operative option when treating patients with low back pain,” says Bryce Basques, an orthopedic spine surgeon and assistant professor at the Warren Alpert Medical School of Brown University. Manipulation of the lower back is considered extremely safe because the area doesn’t have the same vital nerves and arteries that the neck does. “What’s important, though, is for chiropractors to stay within their scope,” Basques continues. “I’m not opposed to chiropractors treating upper back or neck pain within the realm of core strengthening, range of motion exercises, things like that. But with neck manipulation, personally, I do not believe the risk justifies the benefit.”
When I asked chiropractors why they don’t just lay off the neck, they told me that the procedure is simply too big a part of their practice to stop. I got the sense that demanding the adjustment be eliminated would be like telling mechanics to stop doing oil changes. Put simply, the neck is primarily where the patient’s need lies.
That led me to another question: Why are health-insurance companies covering this?
Chiropractic care provides a low-cost, nonsurgical alternative remedy for back pain, and it carries relatively few risks, which is why it’s appealing to the health-insurance industry. Almost no expenditure hits a health insurer’s coffers quite as hard as surgery, and of these procedures, back- and neck-related spinal operations are among the costliest and most common. In a given year, 1.2 million Americans undergo spinal surgery, with procedures for lower back pain costing $90 billion a year; roughly 200,000 are cervical procedures. In addition, back surgeries that don’t fix the initial condition are so common they’re now a condition of their own: Failed-back-surgery syndrome, or FBSS, is estimated to affect as many as 40 percent of those who undergo spinal procedures. Finally, back surgeries are among the most overprescribed operations, with one study finding that over three years, Medicare beneficiaries underwent more than 200,000 unnecessary back-related procedures.
Within this context, health insurers have made no secret of their desire to trim surgical spending, particularly as it relates to musculoskeletal conditions, which affect 124 million Americans over 18 — nearly half of all the nation’s adults. To insurers, chiropractic care is a cost-effective means of weeding out those who might actually need surgery and those whose pain can be addressed through more conservative, and cheaper, treatments. (Of course, insurers won’t shell out for indefinite crackings; most cover a finite number and cut patients off if they haven’t seen results within a few weeks.) In researching the major plans that offer chiropractic coverage, I found none that listed any limits on the kind of manipulation they covered — say, allowing lower-back adjustments but not neck manipulation. I suspect that’s a matter of practicality: If a vast swath of your plan’s members suffer from neck pain, they’ll be none too pleased if they try to use their chiro coverage and find that a whole section of their spine is off-limits.
After all of this reporting, I’ve concluded that whether to get your neck cracked is an individual decision, dependent on your own private cost-benefit analysis and your tolerance for risk. But I also know where I fall on that spectrum. I feel lucky that I opted against it, given how little I knew about the field at the time.
Two years ago, I underwent an anterior cervical discectomy and fusion, or ACDF — one of the most common operations conducted on the cervical spine. My neck had hurt for 20 years, I couldn’t stand it any longer, and so I saw an orthopedic surgeon. An MRI revealed that one of my cervical vertebrae had caught on the one above it, likely thanks to a long-ago car accident. The muscles and nerves surrounding them, and the disc squished between them, had been pinched and strained, resulting in chronic pain. More terrifyingly, my cervical spine had for decades been fundamentally unstable, no longer locked in place and thus no longer protecting my spinal cord. The surgeon flatly explained that further injury could result in paralysis, and I burst into tears. “Just don’t ride any roller coasters between now and the surgery,” he joked.
The operation went fine; now, I have a scar on my throat and a neck that only hurts because of screen time, not spinal torquing. But I think often of the desperate pre-surgery years. I bought a dozen orthopedic pillows. I microwaved my buckwheat neck wrap 9,000 times. I got massages and bought foam rollers and cervical stretchers. And I thought seriously about seeing a chiropractor because I was in agony, and the thought of walking out of that office as a regular person with a regular neck was so glorious it almost made me weep. I never did go, however, and I’m thankful I didn’t. For two decades, I’d had no tingling down the arms, no weakness in my hands, no nausea, no difficulty with balance — none of the telltale signs of pinched nerves or bulging discs. I’d had no idea of the dire situation inside my neck. And if I’d gone to see a chiropractor, they wouldn’t have had any idea, either.
This piece is not meant to serve as medical advice and is for informational purposes only. Readers should consult their doctor before undergoing medical treatment.