Introduction Neck manipulations, including massages and self-cracking, are common practices, yet public awareness of their potential risks is poorly understood. This study explores public knowledge and awareness of the risks associated with neck manipulations in the Southern region of Saudi Arabia. Methods The study employed a descriptive cross-sectional design from May 2024 to July 2024, distributing a questionnaire to the adult population in the Southern Region. A convenience sampling technique was used for data collection. The data were initially entered into an Excel spreadsheet for cleaning and subsequently analyzed using SPSS version 27. Results Among the respondents, 154 (39.8%) reported experiencing neck pain, and 196 (50.6%) admitted to engaging in neck manipulation, primarily for comfort (100, 51.0%) or pain relief (35, 17.9%). Despite these practices, 271 (70.0%) were unaware of the serious complications that could result. Most participants performed neck manipulations themselves (39.3%), often learning techniques from social media (75.3%). Key complications identified included neck fractures (44.8%) and paralysis (40.5%), yet awareness of risks like stroke was limited (19.8%). A statistically significant association was found between age and neck pain (p = 0.001). Individuals aged 30-39 reported the highest prevalence of neck pain. By contrast, no significant association was observed between gender and neck pain (p > 0.05). Conclusion There is a critical public knowledge gap regarding neck manipulation complications in the Southern region of Saudi Arabia. The results underscore the necessity for targeted public health interventions to improve awareness and encourage safer practices.