Cervical (neck) adjustments — technically cervical spinal manipulation — are a common chiropractic technique for treating neck pain, headaches, and related conditions. They're also the most scrutinized part of the profession, and worth understanding clearly.
What actually happens
A skilled adjustment applies a fast, low-amplitude, high-velocity thrust to a specific spinal joint. The audible "pop" you sometimes hear is called cavitation — gas releasing from within the joint capsule. The pop itself doesn't matter clinically; the therapeutic effect comes from restoring joint motion, modulating pain-processing pathways, and reducing muscle guarding.
What the evidence supports
Strong evidence for:
- Acute and subacute mechanical neck pain
- Cervicogenic headaches (headaches from the neck)
- Certain types of dizziness (cervicogenic vertigo)
- Combined with exercise for chronic neck pain
Safety in perspective
Serious adverse events from cervical manipulation are extremely rare. The most-cited risk — vertebral artery dissection leading to stroke — has been studied extensively. Current best evidence suggests the association is very low and likely not causal (people with pre-existing dissection often seek care for neck pain, making the temporal association misleading).
Common minor side effects include short-lived soreness or mild headache, similar to what you'd expect after any manual therapy or exercise.
When we do them and when we don't
We adjust when the assessment supports it and the patient is comfortable with the technique. We modify or use alternatives (mobilization, instrument-assisted techniques, muscle-based approaches) when there are risk factors, patient preference, or clinical reasons to avoid manipulation.
Alternatives that also work
Mobilization, Activator instrument, drop-table technique, and flexion-distraction all produce clinical benefit for cervical conditions. The specific technique matters less than the overall treatment plan.
If you have concerns about neck adjustments, bring them up at your visit. We tailor care to what works for each patient.