The death of Katie May last February came as a tragic shock. The model and social media star passed away three days after suffering a stroke at the age of 34.

Now, People reports that May’s stroke was the result of a chiropractic manipulation that tore an artery in her neck. A spokesperson from the Los Angeles Coroner’s Office explained that the tear interrupted blood flow to May’s brain. "I personally have not seen this before," Assistant Chief Coroner Ed Winter said.

Less than a week before her stroke, May tweeted that she had pinched a nerve in her neck during a photo shoot, and had visited a chiropractor. Two days later, she tweeted that her neck still hurt, and she was returning to the chiropractor.

 

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During chiropractic treatment, a practitioner performs manual adjustments (which can involve a rapid thrust) at specific points along the spine. Research suggests the treatment may be effective for relieving muscle-related pain, and unexplained lower-back pain.

But there is a chance, albeit very small, of potentially fatal complications. “It is known within the chiropractic and allopathic medical professions that cervical (neck) spinal manipulation can result in serious injury or death,” says Kimberly Washington, MD, a physician and chiropractor with the Osher Center for Integrative Medicine at the University of California San Francisco. “Though fortunately, this occurrence is very rare.”

The odds are about 1 in 1 million, she wrote in an email to Health, but "estimates range from 1:200,000 to 1:3,000,000 with no clear consensus.”

According to Health’s medical editor, Roshini Raj, MD, a stroke may occur when a chiropractic manipulation overstretches arteries in the neck, leading to a rupture or a clot that prevents blood from reaching the brain. If you’re worried, you can always ask your chiropractor to avoid your neck, she suggests.

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Stroke may be the most serious complication of chiropractic manipulations, but it’s not the only one. Other possible adverse effects include muscle or ligament strain, intervertebral disc injury, and fractures, Dr. Washington pointed out.

As you should do before any procedure, have a conversation with your practitioner about the risks and benefits, the rationale behind the treatment, and the expected outcomes, Dr. Washington urges. “Talking with your healthcare providers, and being an active and informed participant in your care is the best way to ensure all around optimal outcomes," she said.