How Safe is Chiropractic Care?

Chiropractic is widely recognized as one of the safest drugfree,
non-invasive therapies available for the treatment of
back pain, neck pain, headaches, joint pain of the arms or
legs, and other neuromusculoskeletal complaints. Although
chiropractic has an excellent safety record, no health treatment
is completely free of potential adverse effects.
The risks associated with chiropractic, however, are very
small. Many patients feel immediate relief following chiropractic
treatment. But some may experience mild soreness
or aching, just as they might after exercise. Current literature
shows that minor discomfort or soreness following
spinal manipulation typically fades within 24 hours.1
In addition to being a safe form of treatment, spinal manipulation
is incredibly effective, getting patients back on their
feet faster than traditional medical care. Giles and Muller
found that spinal manipulation may provide better shortterm
relief of chronic spinal pain than a variety of medications.
2 Two years later, they found that for treating chronic
mechanical low-back pain and neck pain, spinal manipulation
may provide broader and more significant long-term
benefits than acupuncture or pain-relief medication.3
Neck Adjustments
Neck pain and some types of headaches are sometimes
treated through neck adjustment. Neck adjustment (often
called cervical manipulation) works to improve joint mobility
in the neck, restoring range of motion and reducing
muscle spasm, which helps relieve pressure and tension.
Neck adjustment is a precise procedure that is generally
applied by hand to the joints of the neck. Patients typically
notice a reduction in pain, soreness, and stiffness, along
with an improved ability to move the neck.
Although neck manipulation is a remarkably safe procedure,
some reports have associated high-velocity manipulation
of the neck with a rare injury to one of the arteries in
the neck, which can lead to a certain kind of stroke.
However, the most recent study, published in the February
2008 edition of Spine, suggests that patients are no more
likely to suffer a stroke following a chiropractic neck treatment
than they are after visiting their family doctor’s
office—and concluded that vertebrobasilar artery (VBA)
stroke is a very rare event.4
The study, which analyzed nine years’ worth of data, also
suggests that any observed association between a vertebrobasilar
artery (VBA) stroke and chiropractic manipulation
most likely comes about when patients with an undiagnosed
vertebral artery dissection seek care for neck
pain and headache before they have a stroke. In other
words, patients with a pre-existing arterial injury are sometimes
treated by a doctor of chiropractic for what seems to
be a simple case of neck pain. Instead, patients’ discomfort
turns out to be an evolving case of injury to a neck
artery.
This type of arterial injury often takes place spontaneously
or following everyday activities such as turning the head
while driving, swimming, or having a shampoo in a hair
salon. Patients with this condition may experience neck
pain and headache that lead them to seek professional
care, but the care they receive at that time is not the
cause of the injury.
The best evidence indicates that the incidence of artery
injuries associated with high-velocity upper neck manipulation
is extremely rare—about 1 case in 5.85 million
manipulations.5 To put this risk into perspective, if you
drive more than a mile to get to your chiropractic appointment,
you are at greater risk of serious injury from a car
accident than from your chiropractic visit.
It is important for patients to understand the risks associated
with some of the most common treatments for neck
and back pain—prescription and over-the-counter nonsteroidal
anti-inflammatory drugs (NSAIDs)—as these
options may carry risks significantly greater than those of
manipulation. According to a study from the American
Journal of Gastroenterology, approximately one-third of all
hospitalizations and deaths related to gastrointestinal
bleeding can be attributed to the use of aspirin or NSAIDs
such as ibuprofen.6
Furthermore, surgery for conditions for which manipulation
may also be used carries risks many times greater than
those of chiropractic treatment. Even prolonged bed rest
poses some risks, including muscle atrophy, cardiopulmonary
deconditioning, bone mineral loss, and thromboembolism.
7
Researchers recently completed a comprehensive review
of scientific evidence related to neck pain treatments.
They found at least as much evidence supporting the
safety and effectiveness of common chiropractic treatments,
including manipulation, as for other treatments
such as prescription and non-prescription drugs and surgery.
8
If you are visiting your doctor of chiropractic with upperneck
pain or headache, be very specific about your symptoms.
This will help your doctor offer the safest and most
effective treatment, even if it involves referral to another
health care provider. If the issue of stroke concerns you,
do not hesitate to discuss it with your doctor of chiropractic.
Depending on your clinical condition, he or she can
forgo manipulation and instead can recommend joint
mobilization, therapeutic exercise, soft-tissue techniques,
or other therapies.
Research Ongoing
ACA believes that patients have the right to know about
the health benefits and risks associated with any type of
treatment, including chiropractic. Today, chiropractic
researchers are studying the benefits and risks of spinal
adjustment in the treatment of neck and back pain through
clinical trials and literature reviews.
All available evidence demonstrates that chiropractic treatment
holds an extremely small risk. The chiropractic profession
takes this issue very seriously and engages in
training and postgraduate courses to recognize the risk
factors in patients, and to continue rendering treatment in
the most effective and responsible manner.
Contact Dr. Hillary Hushower for more information,
rangelinechiropractic@gmail.com.

Reprinted with permission from ACA.
References:
1. Senstad O, et al. Frequency and characteristics of side
effects of spinal manipulative therapy. Spine 1997 Feb 15;435-
440.
2. Giles LGF, Muller R. Chronic spinal pain: a randomized
clinical trial comparing medication, acupuncture, and spinal
manipulation. Spine 2003, 15 July;28(14):1490-1502.
3. Muller R, Giles LGF. Long-term follow-up of a randomized
clinical trial assessing the efficacy of medication,
acupuncture, and spinal manipulation for chronic mechanical
spinal pain syndromes. J Manip Physiol Ther 2005;28(1):3-11.
4. Cassidy D, et al. Risk of vertebrobasilar stroke and chiropractic
care. Spine 2008;33(4S):S176–S183.
5. Haldeman S, et al. Arterial dissection following cervical
manipulation: a chiropractic experience. Can Med Assoc J
2001;165(7):905-06.
6. Lanas A, et al. A nationwide study of mortality associated
with hospital admission due to severe gastrointestinal
events and those associated with nonsteroidal anti-inflammatory
drug use. Am J Gastroenterol 2005;100:1685–1693.
7. Lauretti W. The Comparative Safety of Chiropractic. In
Daniel Redwood, ed., Contemporary Chiropractic. NY
Churchill Livingstone, 1997, p. 230-8.
8. Hurwitz E, et al. Treatment of neck pain: noninvasive
interventions. Spine 2008;33(4S):S123-S152.
Jan/Feb 2011
For more information on prevention
and wellness, or to find a doctor of chiropractic
near you, go to the Patient
Information section on ACA’s Web site
at www.acatoday.org or call 800-986-
4636.