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I crack my neck all the time. Is it really dangerous?

-- Laura

If you crack your neck to relieve pain, you aren't alone. By one estimate, chiropractors perform between 18 and 38 million cervical spine manipulation treatments each year. That involves quick motions to loosen the joint and ligaments, which often makes a "pop" sound -- and that helps explain the colloquial term we often use: "cracking."

Cracking isn't just reserved for necks -- people commonly crack their knuckles, lower backs, hips, ankles and toes. Any joint can be "cracked," either by a professional or at home. Here at Healthy Living, several members of our team, along with readers who have written in, want to know if their own cracking is safe.

So what exactly is going on when a neck -- or really any joint area -- pops? Our joints contain fluid and gasses like nitrogen and carbon dioxide. When you put the liquid under pressure, as happens when force is applied to the joint, the gas exits, creating a pop sound, explained Dr. Stephen Perle, a chiropractor and Professor of Clinical Sciences at the University of Bridgeport. Interestingly, though we associate the pop with the dissipation of tension in the ligaments, they just coincide as a result of the movement -- they are unrelated.

Neck cracking was a subject of great interest when the British Medical Journal released commentaries from two sides of a debate: is neck manipulation worth the (admittedly) small risk of grave injury?

Although the practice, which is most popular among chiropractors (the commentary dealt specifically with professional manipulations) is not high risk, rare side effects include stroke brought on by a tear to the lining of the vertebral artery, which supplies blood to the brain. Does the risk outweigh the benefits? As might be expected, divisions within the medical community run along specialist lines. While many chiropractors think the manipulation is useful and safe, orthopedic surgeons are apt to disagree. Because the rate of injury is so low, the treatment looks safe from a public health perspective.

Arguing against neck manipulations in the BMJ, three clinical therapy professors pointed to studies that suggested neck manipulation was no more effective than other treatments, like exercising the muscles that support the spine, that are meant to alleviate the same pain. Given the association between neck cracking and stroke, however inconclusive, why risk it?

In contrast, arguing in favor of the treatment, epidemiologist Dr. David Cassidy of the University of Toronto and colleagues points to the tremendously low risk of stroke, and additional research that shows how neck manipulation can alleviate pain in ways that other treatments cannot. Perle, who is currently researching the relationship between cervical manipulation and stroke, agrees with Team Cassidy.

"We know that spinal manipulation causes stimulation of areas of the brain that block pain, changes the function of the muscles that help support the spine and changes the flexibility of motion segments in the spine," says Perle. "Exercises can help loosen the muscles and other treatments can help with pain, but the flexibility of the joint -- that's uniquely aided by manipulation."

But Dr. Michael R. Marks, an orthopedic surgeon who is a spokesperson for the American Association of Orthopedic Surgery, remains cautious. "When we talk about medical complications, they can be really small, say one percent," says Marks. "But if it happens to you, it's 100 percent."

He suggests that age may be a factor. "If you're a relatively young person, a spinal maniupation is relatively safe because you've got muscle strength, strength in the ligaments, bone strength. But as you age and your blood vessels get a little bit hard, you have some atherosclerosis -- because of the chiropractic manipulation -- you run the risk of artery eruption."

That's not the only age-related concern when it comes to a cervical spine manipulation, according to Marks. Older adults have more porous bones that are more prone to fracture. A quick, forceful motion is more likely to cause fracture in old bones than younger ones.

Luckily, one area where older adults do not need to worry when it comes to manipulations is arthritis. While it's a common myth that joint cracking can lead to arthritis later in life, research consistently shows that there is simply no association.

The bottom line is this: the odds of getting a debilitating injury -- either a vascular injury that results in stroke or a fracture or, a third rare option, nerve damage -- is very low, particularly if you have healthy, strong bones, ligaments and muscles. But do you want to take the chance? Maybe not. Just don't worry about arthritis -- there's no relationship at all.

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