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.


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Each treatment option has potential side effects:

Exercise[edit | edit source]

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

Neck mobilizations[edit | edit source]

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]
NeckPainPatientAid OrangeSmiley Frown.pngNeckPainPatientAid OrangeSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.png
(22 out of every 100 people will experience a short-term increase in neck pain)


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

Neck manipulations[edit | edit source]

  • 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]
NeckPainPatientAid OrangeSmiley Frown.pngNeckPainPatientAid OrangeSmiley Frown.pngNeckPainPatientAid OrangeSmiley half.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.png
(22 to 41 out of 100 people experience a short-term increase in neck pain)


Increased neurological symptoms[2][3]
NeckPainPatientAid OrangeSmiley Frown.pngNeckPainPatientAid OrangeSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.png
(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[edit | edit source]

  • Mild and infrequent side effects including short-term increases in neck, arm, head, or back pain and dizziness are possible
Increased pain[2]
NeckPainPatientAid OrangeSmiley Frown.pngNeckPainPatientAid OrangeSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.pngNeckPainPatientAid YellowSmiley Frown.png
(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 Cite error: Invalid <ref> tag; name "Carnes 2010" defined multiple times with different content
  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.