A routine neck adjustment changed everything for Jonathan Buckelew. What should have been a simple visit to a chiropractor ended in a catastrophic stroke, followed by a delayed diagnosis that left him with locked-in syndrome—a condition that has rendered him fully conscious but nearly entirely paralyzed. His case is extreme, but it highlights a broader issue that doesn’t get enough attention: the overlooked risks of spinal manipulation, the tendency to dismiss stroke symptoms in younger adults, and the high cost of medical errors when protocols break down.
This isn’t about fearmongering or attacking a profession. It’s about transparency, informed decision-making, and accountability. While chiropractic care is widely used and generally considered safe, certain procedures—especially those involving the neck—carry rare but serious risks. When something goes wrong, the outcome can be permanent, and the warning signs are often subtle. Most patients aren’t told this. Even worse, some emergency departments still underestimate how often strokes happen in people under 45, delaying the interventions that could prevent lifelong disability.
A Devastating Turn from Routine to Catastrophic
In 2015, Jonathan Buckelew, a healthy man in his twenties, went to a chiropractor for a neck adjustment and left with life-altering injuries. During the appointment, he became dizzy, confused, and unresponsive. He was taken to North Fulton Hospital in Georgia, where doctors failed to recognize that he was having a brain stem stroke—a severe and time-critical condition. No stroke alert was issued, and his radiographic scans were misread. As a result, Buckelew lost valuable time that could have prevented irreversible damage. When the stroke was finally diagnosed, it was too late. He developed locked-in syndrome, a rare neurological condition where a person remains fully conscious but is almost completely paralyzed and unable to speak, except through limited eye movement.
A lawsuit later revealed that the emergency room doctor, Dr. Matthew Womack, and radiologist James Waldschmidt had missed critical signs and failed to follow basic medical protocols. The ER team didn’t alert the on-call neurologist about the patient’s seizure-like events or the fact that he had seen a chiropractor earlier that day. The court found both doctors grossly negligent, ruling that their failure to act in line with standard procedures directly led to the devastating outcome. Buckelew was awarded $75 million in damages, including $9 million for past medical expenses, $20 million for future care, and $46 million for pain and suffering. Despite the large settlement, his family made clear that no amount of money could make up for the permanent damage done.
Now in his 30s, Jonathan requires 24-hour care provided by his parents and a team of nurses. Their home has been converted into an ICU-level environment, stocked with medical supplies and specialized equipment. He communicates by blinking or using his nose to type on a keypad. His father, Jack Buckelew, said they focus on keeping Jonathan as happy and comfortable as possible, but admitted the emotional toll is immense. “There are some days where he’s like, ‘pull the plug,’” he told reporters. “Those are the tough days.” Despite his family’s relentless support, the case serves as a stark reminder of what can happen when medical systems fail to recognize and act on the warning signs of stroke—especially in young patients where symptoms might be overlooked or dismissed.
The Hidden Risks of Neck Adjustments
Cervical spinal manipulation, commonly known as a neck adjustment, is a technique often used by chiropractors to relieve pain or stiffness. While many people walk away without incident, there’s a documented—though rare—risk of serious complications, including stroke. The concern lies in the vertebral arteries, which run through the neck and supply blood to the brainstem. Forceful manipulation can, in some cases, lead to a tear in these arteries, known as a vertebral artery dissection, which can then trigger a stroke. This mechanism has been cited in multiple peer-reviewed studies and is recognized by neurologists and emergency physicians as a legitimate, if uncommon, medical risk.
The American Heart Association and the American Stroke Association issued a joint scientific statement in 2014 acknowledging that cervical artery dissection can be associated with neck manipulation, particularly in younger patients. While they stopped short of recommending a ban, they emphasized the importance of recognizing early warning signs such as sudden dizziness, vision disturbances, or difficulty speaking—symptoms that should prompt immediate medical evaluation. A 2016 systematic review in the journal CMAJ Open also noted that while causality is difficult to establish in every case, the association between spinal manipulation and vertebral artery dissection is “plausible” and potentially underreported.
Importantly, these risks are not theoretical. There are documented cases of patients, often under age 45, experiencing stroke symptoms within hours of chiropractic adjustments. In some instances, the connection is missed by both the chiropractor and the emergency medical team, leading to delayed diagnosis and irreversible harm—just as it did with Jonathan Buckelew. The challenge is that symptoms can initially appear mild or vague, and unless healthcare providers are trained to consider stroke as a possibility, the window for effective intervention can close quickly. This makes both awareness and communication critical—yet these are often the exact areas where the system breaks down.
Why Strokes in Young Adults Are Often Missed
Strokes are often seen as a condition affecting older adults, but this outdated assumption continues to delay diagnosis in younger patients. While overall stroke rates have declined in older populations, they have been rising steadily among adults under 45. A 2017 study published in JAMA Neurology found that ischemic strokes in young adults increased by as much as 40% over the prior two decades. Despite this trend, emergency departments often fail to prioritize stroke as a diagnosis in younger patients, especially when symptoms are vague or mimic other, less urgent issues like migraines, anxiety, or even substance use.
Part of the problem is cognitive bias—when a young, otherwise healthy person arrives at the ER with symptoms like dizziness, nausea, or temporary numbness, stroke is not the first consideration. This bias is compounded when clinicians fail to take a full medical history or overlook important contextual details, such as a recent chiropractic neck manipulation. In Jonathan Buckelew’s case, ER staff missed multiple red flags, including seizure-like activity and acute disorientation, which should have prompted a stroke alert and immediate neurological evaluation. Instead, critical time was lost, and the resulting delay permanently altered the course of his life.
Medical protocols exist to help reduce these kinds of errors, but they’re only effective when followed. Rapid stroke assessment tools like the NIH Stroke Scale and imaging guidelines are designed to detect even less obvious cases of ischemic stroke, but their success depends on consistent use. The court in Buckelew’s case found that these procedures were not properly followed, and communication between providers was severely lacking. When stroke is diagnosed early—within the first few hours—treatment options like clot-busting medications or mechanical thrombectomy can restore blood flow and minimize brain damage. Once that window closes, options are limited, and outcomes are often devastating.
What You Can Do—Protecting Yourself as a Patient
If you’re considering a chiropractic neck adjustment, it’s important to understand both the potential benefits and the risks—especially those involving the arteries in the neck. While serious complications are rare, they do happen, and being aware of warning signs can make a real difference. Before undergoing any high-velocity neck manipulation, ask your chiropractor about the technique being used, the evidence supporting it, and whether alternative, lower-risk approaches are available. If you have a history of stroke, blood vessel issues, or experience sudden headaches, dizziness, or numbness, bring it up before any adjustment. You have the right to ask questions and pause treatment if something doesn’t feel right.
Know the early signs of stroke. These include sudden weakness or numbness (especially on one side of the body), slurred speech, confusion, vision changes, dizziness, and sudden severe headache. If you or someone you’re with experiences any of these symptoms—regardless of age—treat it as a medical emergency and call for help immediately. Don’t minimize or wait it out. At the hospital, be clear about any recent events that could be relevant, including chiropractic visits, head or neck trauma, or unusual physical activity. This information can help doctors consider stroke as a possibility faster, especially if you’re not in a typical risk group.
When you’re in an emergency setting, don’t assume that all details are being communicated behind the scenes. If you’re able, speak up. If you’re with someone who’s having symptoms, make sure staff are aware of any key facts and ask directly whether stroke has been ruled out. It’s not about being combative—it’s about making sure nothing is overlooked. Bring a list of symptoms and when they started. If something changes while you’re waiting—speech slurs more, dizziness worsens, weakness spreads—notify staff immediately. Time is a critical factor in stroke care, and early action can preserve function and save lives.
The Cost of Delay—and Why Vigilance Matters
Jonathan Buckelew’s case is not just a tragic outlier—it’s a stark reminder of what can happen when gaps in awareness, communication, and clinical decision-making collide. He walked into a chiropractor’s office for something routine and left with locked-in syndrome, a condition so severe it stripped him of nearly every physical function. The healthcare system failed him at multiple points—not just during the chiropractic visit, but during emergency evaluation, imaging, diagnosis, and treatment. His case went to court because the failure wasn’t just unfortunate—it was preventable. The outcome could have been vastly different had medical staff acted within established protocols and communicated vital details clearly and promptly.
For patients and families, this case underlines how critical it is to advocate, ask questions, and not dismiss symptoms simply because they seem unlikely or because you’re young and “healthy.” It’s also a call to healthcare providers—chiropractors, ER doctors, radiologists, and specialists—to recognize that their actions are interconnected. One missed detail, one assumption, one delay in protocol can cause irreversible harm. Stroke doesn’t always follow the script. It doesn’t always come with dramatic collapse or textbook symptoms. Especially in younger patients, stroke can be subtle at first—and that’s exactly why it’s so often missed until it’s too late.
System-wide, there’s a need for better training on recognizing stroke in all age groups, stricter adherence to diagnostic protocols, and more open communication across disciplines. Patients need to know that they’re allowed to question procedures, ask what symptoms mean, and expect that their care team will follow through on critical steps without assumption or shortcut. There is no room for complacency when minutes count. In cases like Buckelew’s, delayed recognition and poor communication were not just oversights—they were the deciding factors in a catastrophic outcome.
No article, verdict, or settlement can undo what happened to Jonathan, but his story should serve as a turning point. If there’s one message to take away, it’s this: don’t ignore symptoms, don’t be afraid to speak up, and don’t assume that youth or fitness means you’re immune. And if you’re in a position to care for someone else—professionally or personally—take every sign seriously. The cost of being wrong is often far greater than the cost of being cautious.
