askST: Should I let anyone ‘crack’ my neck?

SINGAPORE – You might feel good after getting your neck “cracked”, but the manoeuvre can be dangerous.

On Dec 8, various Thai media outlets reported that a Thai woman died after having her neck twisted in three massage sessions in Udon Thani province. She reportedly had numbness in her limbs, among other symptoms, which progressively got worse after each session. The woman later sought medical treatment, but died of blood poisoning, according to the Bangkok Post.

Healthcare professionals The Straits Times spoke to warned that the manoeuvre – common with certain types of massage, and also after haircuts at some local barbers – could result in strokes or worse.

Q: Why is neck ‘cracking’ dangerous?

Overly aggressive, forceful and sudden twisting of the neck risks injury to the carotid and vertebral arteries, said Dr Wang Lushun, an orthopaedic surgeon at Arete Orthopaedic Centre, referring to major blood vessels that carry blood to the head, brain and spine.

Arterial dissection – torn arteries that may lead to blood clots forming and arteries closing – is a key concern, he added. This could eventually lead to tissue death, strokes and death – even if diagnosed early. 

Other potential injuries include those to vital structures, such as the spinal cord, vertebrae body, blood vessels or airway, said another orthopaedic surgeon, Dr Huang Yi Lun of Total Orthopaedic Care and Surgery. For example, aggressive neck “cracking” can cause fractures and dislocation of the spine, destabilising it or injuring the spinal cord, Dr Huang said.

The spine consists of the spinal cord and the vertebrae body. The spinal cord is a tube of nerve tissue running from the base of the skull down the centre of the back, while the vertebrae body is the column of bones that protect the spinal cord.

A spinal cord injury could end in the paralysis of one’s breathing muscles, leading to death. 

“It is rare for someone to die from a manipulation of the cervical spine, but it is not unheard of. In my opinion, it is not necessary to take the risk,” Dr Huang added, referring to the neck area.

Q: What about ‘cracking’ other parts of the spine?

Forceful manipulations of the middle and lower parts of the spine can also lead to injury, the doctors said.

Compared with the neck, these areas of the spine are more resilient against injuries, said Dr Huang, adding that injuries there are less likely to cause death.

But done incorrectly, such manipulations could still risk damaging nerves and the spinal discs, which are positioned between each vertebra and act as a cushion.

Q: Is it safe to ‘crack’ my neck myself?

While there are still risks involved when “cracking” your own neck, especially when done in a sudden or forceful manner, the overall risk of injury is generally lower, the doctors said. Dr Huang explained that this is because “you are generally more careful with yourself compared with a third party”.

Q: Are there ways to reduce the risk?

Dr Wang urged those with neck pain to see a qualified physiotherapist to learn safe and effective neck stretching exercises.

He added that those keen on massages should also seek trained orthopaedic advice for medical evaluation and clearance.

Dr Huang advised that to minimise the risk of injury, any manoeuvres should be done in a gentle and controlled manner, limited by pain, adding that it is vital to avoid sudden and forceful actions.

“Once the individual feels pain, the action has to stop,” he said.

Q: What symptoms should I look out for if I think I have been injured after my neck is ‘cracked’?

Dr Wang warned that post-manoeuvre red flags include severe headaches, slurred speech, a spinning sensation known as vertigo, trouble with balance or coordination, dizziness, hearing loss, and double vision. Other symptoms include intense neck pain, as well as weakness and numbness in the hands, Dr Huang noted.

Those who experience such symptoms after having their neck twisted should seek medical attention immediately.

Q: Should I allow a masseur or chiropractor to ‘crack’ my neck?

Dr Wang said he would not recommend those with neck pain or pre-existing neck conditions to have their necks manipulated suddenly and forcefully.

While such manipulations are commonly practised by chiropractors, osteopaths and physiotherapists, he argued that “there is a lack of good long-term evidence supporting (their) use”.

Dr Huang said the moves are relatively safe when done by a professionally trained masseur or chiropractor, but he advised people to steer clear of such services when in doubt.

He added: “Choose a less forceful and aggressive kind of massage, such as deep-tissue massage and Swedish massage, or choose massage without manipulation.”

Q: But what about chiropractic care?

Although critics have claimed the field lacks scientific validity, chiropractic treatments provide many people with pain relief, and a vast majority take place without incident, The New York Times reported in 2023.

Manipulations done by chiropractors are known as “adjustments”, said chiropractor Luke Ho of Agape Chiropractic Clinic. These adjustments are delivered only to extremely specific faulty joints that have been deduced to cause issues with the patient’s nervous system, health, or body.

“When a ‘manipulation’ has a severe consequence (such as in the case of the Thai woman’s death), many erroneously lump all forms of manipulations together with chiropractic adjustments,” he said, reiterating that they are simply not the same.

He added that many scientific studies have shown that cases of adverse events arising after adjustments done by professionally trained chiropractors are “reassuringly rare”.

Mr Marc Calaunan of Healing Hands Chiropractic agreed, adding that while any form of treatment will have its risks, trained chiropractors are able to minimise them when adjusting specific joints.

Q: How much training do chiropractors have?

Mr Ho said US-trained chiropractors, like himself, must complete a four-year undergraduate degree, and then a five-year Doctor of Chiropractic degree programme. 

“We receive hundreds of hours of technique training in addition to the base curriculum not dissimilar to what a Doctor of Medicine in the US receives,” he said, adding that trainees must undergo a clinical programme and observe “a few hundred” patient encounters before adjusting any patient themselves.

They are required to have 450 patient encounters before graduation, he said.

Q: How do I know if my chiropractor is professionally trained?

Chiropractors in Singapore are registered – but not licensed – as complementary and alternative medicine providers, under the scope of the Healthcare Services Act, according to its website.

Chiropractors are self-regulated by their Singapore-registered associations – such as the Chiropractic Association of Singapore – which ensure their members meet the international standards of chiropractic education and training as set by the World Federation of Chiropractic.

Mr Calaunan urged patients to ensure their health conditions are clinically assessed. A professionally trained chiropractor and clinic, he said, will take a detailed history of the patient’s health and physically examine his or her condition. When visiting any doctor or healthcare provider, be wary of anyone who claims he or she can cure anything, Mr Ho advised patients. He also urged patients to actively clarify any concerns with their chiropractor.

He added: “An experienced chiropractor, who has your health and safety at heart, will take the time to explain everything to you, reassure you, and let you understand the problem and the solution.”

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