Rheumatoid Arthritis and Neck Pain: How Chiropractic Care Is Adapted

Rheumatoid Arthritis and Neck Pain: How Chiropractic Care Is Adapted

By Dr Silver Esho, Spirit Chiropractic, Kogarah NSW · 4 November 2026

Quick summary

• Rheumatoid arthritis (RA) is an inflammatory autoimmune disease managed by your GP and rheumatologist. Medication is central and chiropractic care does not replace it.
• The neck is the part of the spine most often involved in RA, and inflammation can loosen the ligaments that stabilise the top two vertebrae (Mallory et al., 2014).
• Because of this, high-velocity manipulation of the upper neck is avoided in people with RA (Slater et al., 2013; WHO, 2005).
• Regular physical activity is recommended for people with inflammatory arthritis, and gentle manual therapy and exercise can help with associated aches and stiffness (Rausch Osthoff et al., 2018).

If you live with rheumatoid arthritis (RA), you're probably used to thinking about your hands, wrists and feet. Fewer people know that RA can also affect the spine, particularly the neck, and that this changes what kinds of hands-on treatment are safe. This article is for people with RA who also have neck or back pain and want to know where chiropractic care fits.

How RA Can Affect the Neck

RA is a chronic inflammatory disease of the joint linings. In the spine, the cervical (neck) region is the most frequently involved area. A review of cervical RA describes the classic patterns (Mallory et al., 2014):

• Atlantoaxial subluxation: inflammation weakens the ligaments holding the first and second neck vertebrae together, allowing abnormal movement.
• Cranial settling: erosion allows the skull to sink slightly onto the top of the spine.
• Subaxial subluxation: slippage at lower neck levels.

Neck pain is the most common symptom, but it is non-specific. Many people with RA and neck pain have no instability at all. Modern disease-modifying medications have also reduced how often severe neck involvement develops. Still, it is something every practitioner treating someone with RA needs to consider.

See your doctor promptly if you have RA and notice:

• pain at the top of the neck or base of the skull, especially if it is new or worsening
• tingling, numbness or "electric" sensations in the arms or legs, especially when bending the neck forward
• clumsy hands, weakness, or changes in walking or balance
• dizziness, visual disturbance, difficulty swallowing, or a sense of the head "clunking" on movement

These can be signs of instability or pressure on the spinal cord and need medical assessment, usually with imaging.

Why Some Techniques Are Avoided

Because ligament laxity in the upper neck can't be ruled out by feel alone, high-velocity manipulation of the upper neck is avoided in people with RA. Clinical literature on RA-related upper cervical instability highlights the potentially serious consequences of inappropriate manual treatment and the importance of screening (Slater et al., 2013). The WHO's chiropractic safety guidelines list spinal involvement in rheumatoid arthritis among conditions where manipulation of the affected region should not be performed (WHO, 2005). RA is also associated with lower bone density, another reason for a gentle approach.

What Can Help

People with RA often have aches and stiffness that aren't directly from inflamed joints: tight muscles around the neck and shoulders, mechanical low back pain, and deconditioning after flares. These can respond to sensible, safe care:

• Regular physical activity. EULAR recommends physical activity as an integral part of care for people with inflammatory arthritis, including aerobic, strengthening, flexibility and balance exercise, adapted to the individual (Rausch Osthoff et al., 2018).
• Gentle manual therapy for muscles and the lower spine, avoiding thrust techniques to the neck and to any joints that are actively inflamed.
• Pacing around flares, easing back during a flare and rebuilding gradually afterwards.
• Workstation and sleep set-up that reduces neck strain.

Our Approach in Kogarah

At Spirit Chiropractic, if you have RA we'll ask about your diagnosis, medications, disease activity and any neck imaging you've had, and screen for warning signs before any hands-on care. Care is low-force and focused on exercise and comfort. We'll keep your GP or rheumatologist informed, and if anything suggests neck instability we'll refer you for medical review before going further. Chiropractic care does not treat the underlying disease. Please don't change your RA medication without speaking to your doctor.

Related conditions we treat in Kogarah

• Neck pain: how we assess and manage it
• Arthritis & joint degeneration: how we assess and manage it
• Lower back pain: how we assess and manage it

Living with RA and struggling with neck or back aches?
We'll take a careful history, screen for warning signs, use only gentle techniques that suit RA, and help you stay active, working alongside your GP and rheumatologist.

Spirit Chiropractic is at Shop 23/6 Belgrave Street, Kogarah. If your GP has put you on a chronic condition management plan, here's how Medicare works for chiropractic.

Request an appointment Call 0410 420 856

Frequently Asked Questions

Is chiropractic safe for rheumatoid arthritis?

It can be, with the right precautions. High-velocity manipulation of the upper neck is avoided in people with RA because inflammation can loosen the ligaments that stabilise the top of the spine. Gentle, low-force care and exercise, with screening for warning signs, are appropriate for many people.

Can rheumatoid arthritis affect the neck?

Yes. The neck is the part of the spine most often involved in RA. Inflammation can affect the ligaments and joints at the top of the neck, sometimes causing instability. New upper neck pain or nerve symptoms in someone with RA should be assessed by a doctor.

What exercise is good for rheumatoid arthritis?

EULAR recommends regular physical activity for people with inflammatory arthritis, including aerobic, strengthening, flexibility and balance exercise, adapted to the individual and adjusted around flares.

Can chiropractic treat rheumatoid arthritis itself?

No. RA is an autoimmune disease that needs medical management, usually with disease-modifying medication prescribed by a doctor or rheumatologist. Chiropractic care may help with associated muscle and back aches, alongside medical treatment.

What are warning signs of neck instability in RA?

Warning signs include pain at the top of the neck or base of the skull, tingling or electric sensations in the arms or legs, clumsy hands, balance or walking changes, and dizziness or swallowing difficulty. These need prompt medical review.

References

• Mallory, G.W., Halasz, S.R., & Clarke, M.J. (2014). Advances in the treatment of cervical rheumatoid: less surgery and less morbidity. World Journal of Orthopedics, 5(3), 292–303. https://doi.org/10.5312/wjo.v5.i3.292
• Slater, H., Briggs, A.M., Fary, R.E., & Chan, M. (2013). Upper cervical instability associated with rheumatoid arthritis: what to 'know' and what to 'do'. Manual Therapy, 18(6), 615–619. https://doi.org/10.1016/j.math.2013.01.005
• World Health Organization. (2005). WHO guidelines on basic training and safety in chiropractic. Geneva: WHO.
• Rausch Osthoff, A.K., Niedermann, K., Braun, J., et al. (2018). 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Annals of the Rheumatic Diseases, 77(9), 1251–1260. https://doi.org/10.1136/annrheumdis-2018-213585

This article is general information, not a diagnosis or a substitute for an individual assessment. If you have new or worsening symptoms, see a registered health practitioner.