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Chiropractic Safety and Side Effects

Side effects and risks depend on the specific type of chiropractic treatment used. For example, side effects from chiropractic adjustments can include temporary headaches, tiredness, or discomfort in parts of the body that were treated. The likelihood of serious complications, such as stroke, appears to be extremely low and related to the type of adjustment performed and the part of the body treated.

To summarize evidence from case reports of adverse events after cervical spine manipulation. Most were treated by chiropractors. Arterial dissection causing stroke was reported in at least 18 cases. Serious adverse events after cervical spine manipulation continue to be reported. As the incidence of these events is unknown, large and rigorous prospective studies of cervical spine manipulation are needed to accurately define the risks.
- Med J Aust. 2002 Apr 15;176(8):376-80. - Manipulation of the cervical spine: a systematic review of case reports of serious adverse events, 1995-2001. - Ernst E.

The aim of this systematic review was to summarize the evidence about the risks of spinal manipulation. Data from prospective studies suggest that minor, transient adverse events occur in approximately half of all patients receiving spinal manipulation. The most common serious adverse events are vertebrobasilar accidents, disk herniation, and cauda equina syndrome. Estimates of the incidence of serious complications range from 1 per 2 million manipulations to 1 per 400,000. Given the popularity of spinal manipulation, its safety requires rigorous investigation.
- Am J Med. 2002 May;112(7):566-71. - Risks associated with spinal manipulation. - Stevinson C, Ernst E.

Concern about cerebrovascular accidents after cervical manipulation is common. It appears that the risk of cerebrovascular accidents after cervical manipulation is low, considering the enormous number of treatments given each year, and very much lower than the risk of serious complications associated with generally accepted surgery. Provided there is a solid indication for cervical manipulation, we believe that the risk involved is acceptably low and that the fear of serious complications is greatly exaggerated.
- J Manipulative Physiol Ther. 2003 Jan;26(1):48-52. - Is cervical spinal manipulation dangerous? - Licht PB, Christensen HW, Hoilund-Carlsen PF.Joint Bone Spine.

Osteoporosis contraindicates spinal manipulation at any level, including the cervical spine.
- 2004 May;71(3):246-50. - Osteoporotic fracture of the dens revealed by cervical manipulation. - Ea HK, Weber AJ, Yon F, Liote F.

Little scientific support is available concerning usual and unusual reactions after spinal manipulation although such reactions are very common in clinical practice. The most common were headache, stiffness (19.5%), local discomfort, radiating discomfort and fatigue. Most of these reactions began within 4h and generally disappeared within the next 24 hours. Women were more likely to report adverse effects than men. The results of this study indicate that reactions to spinal manipulation may be relatively common but are benign in nature and of short duration. Although it is difficult to label side effects as a risk, it is important to differentiate those patients who are susceptible to side effects in order to inform them correctly.
- Man Ther. 2004 Aug;9(3):151-6. - How common are side effects of spinal manipulation and can these side effects be predicted? - Cagnie B, Vinck E, Beernaert A, Cambier D.

Chiropractic Resources

last update: April 2009

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