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Safety Issues
Chiropractic manipulation appears to be generally safe—rarely causing serious side effects. 1 2 3 However, a temporary increase of symptoms may occur relatively frequently. 4 Other side effects include temporary headache, tiredness, and discomfort radiating from the site of the adjustment.
More serious complications may occur on rare occasions. These are primarily associated with manipulation of the neck. Articles have been published that document a total of almost 200 cases of more serious complications associated with neck manipulation, including stroke, vertebral fracture, disc herniation, severely increased sensation of nerve pinching, and rupture of the windpipe. 5 6 7 8 9 10 11 12 13 More than half of these reports involve some form of stroke, often due to a tear in a major blood vessel at the base of the neck (the vertebral artery).
Although attempts have been made to determine in advance who will experience strokes following chiropractic, they have not been successful. 14 Thus, stroke must be considered an unpredictable, though rare, side effect of chiropractic manipulation of the neck. To put this in perspective, however, the rate of complications from chiropractic is extremely low. According to one estimate, only one complication per million individual sessions occurs. 15 Among people receiving a course of treatment involving manipulation of the neck, the rate of stroke is perhaps one per 100,000 people; the rate of death is one per 400,000. 16 By comparison, serious medical complications involving common drugs in the ibuprofen family (non-steroidal anti-inflammatory drugs, or NSAIDs) are far more common. Among people using them for arthritis, NSAIDs result in hospitalizations at a rate of about four in 1,000 people, and death at a rate of four in 10,000. 17 To put it another way, the rate of complications with these common over-the-counter drugs is perhaps 100 to 400 times greater than with chiropractic.
Certain health conditions preclude spinal manipulation, such as nerve impingement causing severe nerve damage, or significant disease of the spinal bones.
References
- Senstad O, Leboeuf-Yde C, Borchgrevink C. Frequency and characteristics of side effects of spinal manipulative therapy. Spine (Phila Pa 1976). 22(4):435-40; discussion 440-1.
- Senstad O, Leboeuf-Yde C, Borchgrevink CF. Side-effects of chiropractic spinal manipulation: types frequency, discomfort and course. Scand J Prim Health Care. 14(1):50-3.
- Ernst E. Prospective investigations into the safety of spinal manipulation. J Pain Symptom Manage. 21(3):238-42.
- 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 (Phila Pa 1976). 30(13):1477-84.
- Frumkin LR, Baloh RW. Wallenberg's syndrome following neck manipulation. Neurology. 40(4):611-5.
- Michaeli A. Reported occurrence and nature of complications following manipulative physiotherapy in South Africa. Aust J Physiother. 1993;39:309-315.
- Frisoni GB, Anzola GP. Vertebrobasilar ischemia after neck motion. Stroke. 22(11):1452-60.
- Hufnagel A, Hammers A, Schönle PW, Böhm KD, Leonhardt G. Stroke following chiropractic manipulation of the cervical spine. J Neurol. 246(8):683-8.
- Stevinson C, Honan W, Cooke B, Ernst E. Neurological complications of cervical spine manipulation. J R Soc Med. 94(3):107-10.
- Lee KP, Carlini WG, McCormick GF, Albers GW. Neurologic complications following chiropractic manipulation: a survey of California neurologists. Neurology. 45(6):1213-5.
- Klougart N, Leboeuf-Yde C, Rasmussen LR. Safety in chiropractic practice, Part I: The occurrence of cerebrovascular accidents after manipulation to the neck in Denmark from 1978-1988. J Manipulative Physiol Ther. 1996;19:371-377.
- Assendelft WJ, Bouter LM, Knipschild PG. Complications of spinal manipulation: a comprehensive review of the literature. J Fam Pract. 42(5):475-80.
- Rivett DA, Milburn P. Complications arising from spinal manipulative therapy in New Zealand. Physiotherapy. 1997;83:626-632.
- Haldeman S, Kohlbeck FJ, McGregor M. Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation. Spine (Phila Pa 1976). 27(1):49-55.
- Coulter ID. The Appropriateness of Manipulation and Mobilization of the Cervical Spine. Santa Monica, CA: Rand Corporation; 1996.
- Dabbs V, Lauretti WJ. A risk assessment of cervical manipulation vs. NSAIDs for the treatment of neck pain. J Manipulative Physiol Ther. 18(8):530-6.
- Dabbs V, Lauretti WJ. A risk assessment of cervical manipulation vs. NSAIDs for the treatment of neck pain. J Manipulative Physiol Ther. 18(8):530-6.
