The incident of the 28-year-old Oklahoman man, Josh Hader, who developed a stroke after stretching his sore neck sparked the discussion about neck cracking or stretching. Is it safe or harmful?

Neck cracking: Risky or harmless?

There exists a link between neck cracking and stroke, at least for some, says neurologists. The co-medical director of the stroke program at UCLA Medical Center in Santa Monica, CA, Doojin Kim MD, said, “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.”

Though he did not treat Hader, he spoke generally about neck cracking. He said, ”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.”

Steven Messe MD, an associate professor of neurology at the University of Pennsylvania Perelman School of Medicine in Philadelphia, also spoke in general saying, “The risk of cracking is not entirely understood.”

”The vertebral arteries run into the bones of the spinal column of the neck. You can potentially end up blocking that artery when you crack your neck.”

Messe said,

“I tell 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.”

Keith Overland, DC, who has a chiropractic practice in Norwalk, CT, and is a past president of the American Chiropractic Association, however, says that neck cracking done very rarely “is not bad,” but people should not make a habit of it.

He also acknowledges that “it has become a habit” for some such that they crack their neck multiple times a day. Overland adds that some people may have a condition or genetic weakness and cracking could strain the neck too much.

Professional neck manipulation: How safe is it?

Now to the cervical manipulative therapy (CMT) that involves applying thrust to the neck and cervical spine, done by chiropractors, osteopaths, and physical therapists. What about it?

The American Heart Association and American Stroke Association concluded in a scientific statement issued in 2014 that moving the neck that way has been linked to cervical dissection. That is a tear in the artery that can lead to a blood clot and a stroke.

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

Overland responded by citing a study in which researchers looked at the force applied during spinal manipulation, working on cadavers. They found the strain unlikely to damage the artery. Patients that develop a stroke after having their neck manipulated may already have been at risk for stroke, he says.

He noted that therapy can help neck issues in carefully selected patients. However, he would not perform it on a patient who already had visual disturbances, severe headaches or sudden dizziness.

Josh Hader’s story

Hader wanted to stretch his neck 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. Suddenly, he heard a pop and then everything went wrong. “His left side started to go numb,” he says. “I used to be a police officer, so I knew it could be a stroke.”

At the hospital, the doctors confirmed it was a stroke. They gave him the clot-buster drug called tPA (tissue plasminogen activator). Then they transferred him to a larger hospital in Oklahoma City.

He stayed in the intensive care unit for a while. Then he was moved to the inpatient rehab facility for a week and a half. Hader has now graduated to outpatient physical therapy.

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

Hader has decided to give up neck stretching. He won’t be touching his neck even if it gets sore. Thankfully, he is walking better now, and a happy ending is in sight.