You can’t depend on the internet. Even if it’s New York Times!

A couple of weeks ago, New York Times just published an article on the safety of getting your neck adjusted by a chiropractor. Honestly, this has been discussed so many times and the article offered no new information. I highly don’t recommend reading it.

The studies they cited were from years ago. There were also many quotes from medical professionals (e.g., TikTok influencer Dr. Betsy Grunch) with no follow-up on if these opinions are supported by research studies.

For example, the article mentioned that a certain Dr Hilibrand (chief of spine surgery at the Rothman Orthopaedic Institute in Philadelphia) recommends over-the-counter pain medications as first-line treatment.

Um, hello? There is a plethora of evidence to suggest that over-the-counter pain medications do not help with chronic pain. Furthermore, clinical guidelines (even those from the United States) do not have medication listed as first-line treatment!

I understand the appeal of quoting a famous physician But appeal to authority is literally a fallacy! Please at least follow-up with studies that either support or refute their suggestion. This will ultimately benefit your reader!

It is a bit concerning that you directed your readers from chiropractic adjustments, which you agree as largely safe, to a treatment that is no better or even worse!

Medication is not first-line treatment. Not for many years.

panadol singapore, neck pain
This may come as a surprise to some of you but paracetamol is not known to be effective for spinal pain! While some studies show that it does help for hip or knee osteoarthritis, a study published earlier this year found it to be no better than exercise.

It is true that there are not as many clinical guidelines for neck pain as there are for back pain. I’ll give you that. However, they do exist. It’s absolutely disappointing that the journalist made zero reference to them!

A study investigating clinical guidelines reported weak evidence to support the use of medication for neck pain. According to the authors, weak evidence means the recommendations were based on experts rather than clinical studies. In other words, there is no real evidence to suggest that medication is helpful.

But this didn’t stop Dr Hilibrand from claiming them to be first-line treatment.

To push my argument further, clinical guidelines for low back pain recommended entirely non-pharmacological treatments. This makes sense because  over-the-counter paracetamol was found to be ineffective against spinal pain. As for NSAIDs, the relief they provide is indeed more than placebo. However, this improvement is small and non-meaningful. In other words, medication has little to no place in management of low back pain.

Yes, take that.

What is plausible doesn’t mean it is real

Now to TikTok star Dr Grunch. I get that Dr Grunch is a neurosurgeon so she would know her anatomy really well. However, she is the wrong person to quote if you want to talk about blood vessels. How about speaking to a vascular neurosurgeon instead?

According to Dr Grunch, our blood vessels will rotate within the bone when we turn our neck side to side. In complete honesty, this is also not my subject matter expertise so I am not familiar with the literature on that. But sure, it makes sense (i.e., plausible) so I will give her the benefit of the doubt.

She also suggested that the arteries in the neck can get “abruptly torqued” during a chiropractic adjustment.


So what?

Are your readers supposed to assume that this torque, supposed it is true, is enough to lead to a change in blood flow to the brain to result in a stroke?

Are your readers supposed to assume that this torque, supposed it is true, is high enough to dissect the arteries in the neck leading to a stroke?

Again, like I said, it sounds like it makes sense. But could we please have some hard data to show that this is true?

Your brain is still well perfused during a chiropractic adjustment

jesse cai, chiropractic adjustment singapore
We did offer chiropractic adjustments many years ago but stopped because our clients were simply not getting better.

In a study published in 2019, researchers found that blood flow in the vertebral arteries (i.e., blood vessels in the neck) does indeed decrease during rotation. This decrease, however, does not result in a reduction of brain perfusion (as compared to being in a neutral neck position).

In other words, your brain gets the same amount of oxygen regardless of the position you are in during a chiropractic adjustment or if you are sitting perfecting upright. I get that spinal manipulation may look scary because of what we associate with it (e.g., snapping of necks in action films). What we are interested in, however, is not if it is scary but if it is actually dangerous!

This was left out in the New York Times article and I personally think it should have been included to give perspective to topic.

Is chiropractic adjustment safe?

chiropractic clinic singapore
Not many people know this but exercise has been part of chiropractic treatments since its founding days. If you are not comfortable with receiving adjustments, you can consider exercise as treatment for your chronic pain. Exercise is the first-line treatment for virtually all joint and muscle conditions.

Honestly, yes. There is really no research to suggest that chiropractic adjustments can cause strokes. Yes, we do know of people who experience stroke after seeing a chiropractor. This may be true.

Having said that, this does not mean the chiropractor caused the stroke.

The article did cite the paper to show that people who consulted with a primary care doctor (e.g., family GP) are just as likely to get a stroke. In my opinion, this is something that should have been further elaborated in the article because it explains why there is no association between chiropractic adjustments and stroke.

From a logical point of a view, if the chances of getting a stroke from seeing a chiropractor and a family physician is comparable, then it is equally safe or equally dangerous to consult either practitioner. You cannot in good faith say that seeing a chiropractor is dangerous for you without being able to demonstrate the safety issues beyond what is assumed to be true!

In fact, from just this post, it should be clear that practitioners’ quote cannot be assumed to be true. Even if they are famous!

Critical thinking skills is important. Don’t trust everything you read.

Call me cynical but I don’t believe that the NYT article is written to help you. As mentioned earlier, there is no new information offered in the article.

Furthermore, the article was posted on 15 a week after news of Caitlin Jensen returning home was gaining traction on the internet. Caitlin Jensen was the Georgia Southern University student who suffered strokes and heart attacks after seeing a chiropractor for neck pain.

If you asked me, the article was probably written because there was reader interest. It was likely written to sell ad space. Not to help you.

The amount of studies cited in the article was relatively low. The article was full of quotes from people rather than actually looking into what the evidence says. Even when studies were cited, the journalist made poor attempts at helping readers make sense of it.

What should you do about your neck pain

shoulder pain, rotator cuff tear, singapore exercise
Singapore lawyer Joshua Woo working on a shoulder rehabilitation exercise. While there is barely any tension on the band, it is still no easy feat for the fitness buff

High-quality guidelines consistently recommended the following evidence-based treatment options: reassurance, advice and education (including to remain active and exercise).

Guidelines are clear that exercise and education should be considered when it comes to management of neck pain. It’s true that some guidelines still include manual therapy such as spinal manipulation or soft tissue therapy as recommended treatments. However, we can expect them to be phased out once they are being updated.

The reason exercise and education is superior to passive treatments such as chiropractic adjustments is because it allows for self-management. You can exercise on your own and get good results from doing so. When it comes to spinal adjustment, most people are unable to do it on their own body. Even if they are able to, the results are often poor and risk of injury has been reported to be high.

When you put all of this together, it then becomes obvious why exercise can deliver long-term results while other treatments cannot. Sure, you may need professional help in the early stages to you get started with exercising. Once that is done, you will have the option to do it on your own without having to rely on anyone.

If you have been struggling with persistent neck pain, drop us a message below to find out how we can help you find freedom from pain.




Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.

Our goal? To make our own services redundant to you.

*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.