A 2012 systematic review concluded that no accurate assessment of risk-benefit exists for cervical manipulation.[15] A 2010 systematic review stated that there is no good evidence to assume that neck manipulation is an effective treatment for any medical condition and suggested a precautionary principle in healthcare for chiropractic intervention even if a causality with vertebral artery dissection after neck manipulation were merely a remote possibility.[17] The same review concluded that the risk of death from manipulations to the neck outweighs the benefits.[17] Chiropractors have criticized this conclusion, claiming that the author did not evaluate the potential benefits of spinal manipulation.[158] Edzard Ernst stated "This detail was not the subject of my review. I do, however, refer to such evaluations and should add that a report recently commissioned by the General Chiropractic Council did not support many of the outlandish claims made by many chiropractors across the world."[158]
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Don’t medically investigate neck pain until it’s met at least three criteria: (1) it’s been bothering you for more than about 6 weeks; (2) it’s severe and/or not improving, or actually getting worse; and (3) there’s at least one other “red flag” (age over 55 or under 20, painful to light tapping, fever/malaise/nausea, weight loss, nasty headache, severe stiffness, very distinctive pain, and numbness and/or tingling and/or weakness anywhere else). Note that signs of arthritis are not red flags.
Figure 1. (side view) The neck region is called the cervical spine. Protected within the bones of the cervical spine are the spinal cord and nerves. The seven cervical bones (vertebrae) are numbered C1 to C7. Each bone is separated and cushioned by shock-absorbing discs. The spinal nerves pass through bony canals to branch out to the neck and arms.
A 2012 systematic review concluded that no accurate assessment of risk-benefit exists for cervical manipulation.[15] A 2010 systematic review stated that there is no good evidence to assume that neck manipulation is an effective treatment for any medical condition and suggested a precautionary principle in healthcare for chiropractic intervention even if a causality with vertebral artery dissection after neck manipulation were merely a remote possibility.[17] The same review concluded that the risk of death from manipulations to the neck outweighs the benefits.[17] Chiropractors have criticized this conclusion, claiming that the author did not evaluate the potential benefits of spinal manipulation.[158] Edzard Ernst stated "This detail was not the subject of my review. I do, however, refer to such evaluations and should add that a report recently commissioned by the General Chiropractic Council did not support many of the outlandish claims made by many chiropractors across the world."[158]
A personal worry example One day I became convinced that the terrible stubborn pain in my neck had to be a cancer. It was one of the lowest moments of my life. The pain had been escalating slowly for months, and eventually it got so severe and unrelenting that I lost my cool. But then, after an emergency massage appointment, I felt almost completely better…and that particular pain never bothered me again.
A 2012 systematic review suggested that the use of spine manipulation in clinical practice is a cost-effective treatment when used alone or in combination with other treatment approaches.[160] A 2011 systematic review found evidence supporting the cost-effectiveness of using spinal manipulation for the treatment of sub-acute or chronic low back pain; the results for acute low back pain were insufficient.[11]
A 2016 study Goertz contributed to showed that about 14 percent of people have seen a chiropractor in the last year. Of those with significant neck or back pain, 33 percent said chiropractic care was safest compared with 12 percent who say pain medications are safer (physical therapy was perceived as safest), according to Gallup data. Also, 29 percent say chiropractic care is more effective than pain medication for those who have neck or back pain, while 22 percent preferred medication over chiropractic care.
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In the U.S., chiropractors perform over 90% of all manipulative treatments.[210] Satisfaction rates are typically higher for chiropractic care compared to medical care, with a 1998 U.S. survey reporting 83% of respondents satisfied or very satisfied with their care; quality of communication seems to be a consistent predictor of patient satisfaction with chiropractors.[211]
No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that other medical physicians could "steal" SM procedures from chiropractors.[70] A focus on evidence-based SM research has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks.[70] Two U.S. states (Washington and Arkansas) prohibit physical therapists from performing SM,[71] some states allow them to do it only if they have completed advanced training in SM, and some states allow only chiropractors to perform SM, or only chiropractors and physicians. Bills to further prohibit non-chiropractors from performing SM are regularly introduced into state legislatures and are opposed by physical therapist organizations.[72]

If your chiropractor does recommend an X-ray, one piece of advice: wear proper clothing! I made the mistake of wearing jeans to the appointment. And that meant had to change into some not-so-attractive disposable medical shorts… NOT a good look. I would recommend wearing loose-fitting clothing you can move in (that helps for the movement assessment too!) and nix the jewelry. I was smarter for my second appointment and wore my workout gear, so the medical shorts didn’t have to make a second appearance.
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