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Neck Pain Patient Decision Aid: Step 3

This page is part of the 'Should I receive manual therapy and exercise for my neck pain?: A patient decision aid' resource for patients. Please see the main project page for further information, or proceed to Step 3 below to recognize the risks.


Each treatment option has potential side effects:

Exercise

  • Mild and infrequent side effects such as short-term increases in neck, arm, head or back pain, muscle soreness, and dizziness have been reported.
Increased neck pain[1]

(29 out of every 100 patients will experience a short-term increase in neck pain)

Neck mobilizations

Mild and infrequent side effects including short-term increases in neck, arm, head, or back pain and dizziness are possible.

Increased neck pain[2][3]

(22 out of every 100 people will experience a short-term increase in neck pain)


Increased neurological symptoms[2][3]
(10 out of 100 people will experience some short-term neurological symptoms [pins and needles sensation, weakness, or numbness])

Neck manipulations

  • Mild and infrequent side effects including short-term increases in neck, arm, head, or back pain and dizziness are possible
Increased neck pain[2][3][1]
(22 to 41 out of 100 people experience a short-term increase in neck pain)


Increased neurological symptoms[2][3]

(19 out of every 100 people experience short-term neurological symptoms)


  • Very rare, but serious or catastrophic side effects such as unbearable symptoms or stroke have also been reported. 
    • Unbearable symptoms[1]
      (Approximately 1 out of every 10 000 experience ‘unbearably severe side effects’)
    • Stroke or death[2][1]
      (It is difficult to determine the frequency of these adverse event due to the small number of participants in each study, but it is likely much less than 1/10 000) 

Upper back manipulations

  • Mild and infrequent side effects including short-term increases in neck, arm, head, or back pain and dizziness are possible
Increased pain[2]
(21 out of every 100 patients experience a short-term increase in pain)


  1. ↑ 1.0 1.1 1.2 1.3 Carnes D et al. Adverse events and manual therapy: A systematic review. Man Ther 2010; 15:355–63
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Carlesso LC et al. Adverse events associated with the use of cervical manipulation and mobilization for the treatment of neck pain in adults: A systematic review. Man Ther 2010; 15: 434-444.
  3. ↑ 3.0 3.1 3.2 3.3 Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM. Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study. Spine. 2005;30(13):1477-84.
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